Waiting for health care, fingers crossed

[charrison]

Linkage

THERE HAS BEEN plenty of talk, but much less action, when it comes to addressing the wait times for health care procedures endured by Canadians.

The issue of wait times to see specialists and obtain treatment was a key element of the Romanow commission report on health care last year, and a top priority in a federal-provincial deal last January to increase health care funding.

But a report released this week by the Fraser Institute has found that median wait times in Canada have actually increased seven per cent this year and escalated a dramatic 90 per cent over the past decade.

...

Overall, the average wait time is 17.7 weeks. In Nova Scotia, which is one of seven provinces in which wait times increased since last year, the wait time on average is 19.4 weeks.

There were decreases in the wait times in Ontario, British Columbia and Saskatchewan, even though Saskatchewan has the worst waits in the country, averaging 29.9 weeks. Second-worst is Newfoundland at 21.8 weeks, followed by Quebec at 20.1 weeks.


Ontario has the shortest waits at 14.3 weeks, Manitoba is next at 15.1 weeks and British Columbia ranks third, with patients waiting 17.6 weeks on average.

...

There were a few bright spots for Nova Scotia in the findings, including a four-week wait for a CAT scan, which is among the lowest in the country. But the wait for an MRI in Nova Scotia is 24 weeks, which ties with Newfoundland for the longest wait time. Hopefully, new MRIs purchased by Nova Scotia will quickly put a dent in that statistic.

But it takes 12 weeks to see a plastic surgeon, ophthalmologist, or an orthopedic surgeon in this province.

[/quote]

 

[MonstaThrilla]

Does the existence of a poorly run (or mediocre) univeral healthcare program in Canada mean that we as Americans should not even try it? Is it not possible that we could actually devise a better system?

 

[SuperTool]

I guess they would be better off if they couldn't afford to see a specialist, cust then they wouldn't be waiting

 

[DealMonkey]

I suppose charrison's point is that the U.S. simply can't do any better than our friends to the North. Who knows though, since there was no elaboration.

 

[Fencer128]

If you have to wait a year for an operation that won't bankrupt you then I really see it as a fair trade off.

The downsides of an NHS are often exaggerated, especially when you see the costs of private healthcare (on an individual basis).

Cheers,

Andy

 

[charrison]

Originally posted by: DealMonkey
I suppose charrison's point is that the U.S. simply can't do any better than our friends to the North. Who knows though, since there was no elaboration.

No, my point is that universal healthcare is not a perfect system.

 

[dmcowen674]

Originally posted by: charrison

Originally posted by: DealMonkey
I suppose charrison's point is that the U.S. simply can't do any better than our friends to the North. Who knows though, since there was no elaboration.

No, my point is that universal healthcare is not a perfect system.

and what the U.S. has here is perfect?

 

[rudder]

Originally posted by: Fencer128
If you have to wait a year for an operation that won't bankrupt you then I really see it as a fair trade off.

I have never had kidney stones, but I could not imagine waiting 17 weeks to get them looked at. My brother-in-law gets them frequently and he cannot function at all.

 

[CADsortaGUY]

Originally posted by: dmcowen674

Originally posted by: charrison

Originally posted by: DealMonkey
I suppose charrison's point is that the U.S. simply can't do any better than our friends to the North. Who knows though, since there was no elaboration.

No, my point is that universal healthcare is not a perfect system.

and what the U.S. has here is perfect?

I think a point he was trying to throw out was that people are trying to say how great Canada's Healthcare system is and that we should have something like it. Neither is perfect, but we sure don't need to follow their plan

CkG

 

[charrison]

Originally posted by: CADkindaGUY

Originally posted by: dmcowen674

Originally posted by: charrison

Originally posted by: DealMonkey
I suppose charrison's point is that the U.S. simply can't do any better than our friends to the North. Who knows though, since there was no elaboration.

No, my point is that universal healthcare is not a perfect system.

and what the U.S. has here is perfect?

I think a point he was trying to throw out was that people are trying to say how great Canada's Healthcare system is and that we should have something like it. Neither is perfect, but we sure don't need to follow their plan

CkG

That is exactly what was meant.

 

[ElFenix]

Originally posted by: Fencer128
If you have to wait a year for an operation that won't bankrupt you then I really see it as a fair trade off.

The downsides of an NHS are often exaggerated, especially when you see the costs of private healthcare (on an individual basis).

Cheers,

Andy

what is the cost of national health care on an individual basis?

 

[Witling]

Rudder -- udder distortion in you statement about 17 weeks for kidney stones. The article says only that the average wait is 17 weeks. It says nothing about a specific condition.

 

[ElFenix]

Originally posted by: Whitling
Rudder -- utter distortion in you statement about 17 weeks for kidney stones. The article says only that the average wait is 17 weeks. It says nothing about a specific condition.

fixed for you

 

[BaliBabyDoc]

But it takes 12 weeks to see a plastic surgeon, ophthalmologist, or an orthopedic surgeon in this province.

Try doing any of that in the US . . . without top tier insurance.

A common use of CT scans is to establish the absence of a mass effect before doing a lumbar puncture for suspected meningitis. Best evidence is that few people actually need imaging but it is still considered part of the standard of care. If we did not have CT scan we would spend far less in the treatment of meningitis but the quality of care would be minimally affected for the vast majority of patients.

As I stated in another thread, the current wait for an evaluation in our pediatric psychiatry clinic is 6-8wks and then we all but guarantee you will NOT get continuing care at our facility (NC's flagship hospital). An autism evaluation will require a wait of 12-18 months . . . for a condition in which early intervention is considered paramount. An astute family doctor or pediatrician can identify troubling developmental trends and then tell the family they have to wait the equivalent of the child's lifespan before it can be followed up. Nothing like having elite healthcare . . . while waiting for health care, fingers crossed.

 

[MonstaThrilla]

Originally posted by: charrison

Originally posted by: CADkindaGUY

Originally posted by: dmcowen674

Originally posted by: charrison

Originally posted by: DealMonkey
I suppose charrison's point is that the U.S. simply can't do any better than our friends to the North. Who knows though, since there was no elaboration.

No, my point is that universal healthcare is not a perfect system.

and what the U.S. has here is perfect?

I think a point he was trying to throw out was that people are trying to say how great Canada's Healthcare system is and that we should have something like it. Neither is perfect, but we sure don't need to follow their plan

CkG

That is exactly what was meant.

Ok, so why don't you bother to answer the questions posed to you? You can start with mine:

Does the existence of a poorly run (or mediocre) univeral healthcare program in Canada mean that we as Americans should not even try it? Is it not possible that we could actually devise a better system?

 

[charrison]

Originally posted by: MonstaThrilla

Originally posted by: charrison

Originally posted by: CADkindaGUY

Originally posted by: dmcowen674

Originally posted by: charrison

Originally posted by: DealMonkey
I suppose charrison's point is that the U.S. simply can't do any better than our friends to the North. Who knows though, since there was no elaboration.

No, my point is that universal healthcare is not a perfect system.

and what the U.S. has here is perfect?

I think a point he was trying to throw out was that people are trying to say how great Canada's Healthcare system is and that we should have something like it. Neither is perfect, but we sure don't need to follow their plan

CkG

That is exactly what was meant.

Ok, so why don't you bother to answer the questions posed to you? You can start with mine:

Does the existence of a poorly run (or mediocre) univeral healthcare program in Canada mean that we as Americans should not even try it? Is it not possible that we could actually devise a better system?

I did not aware it was posed directly at me.


I think our system has problems that need addressing. But overall I think our system will work better than a system run by the goverment.

 

[BaliBabyDoc]

I think our system has problems that need addressing. But overall I think our system will work better than a system run by the goverment.

Clearly, some people have no idea how much of our current healthcare system is run by the government in one capacity or another . . . and it's not just the poorly functioning aspects that are government run.

 

[charrison]

Originally posted by: BaliBabyDoc

I think our system has problems that need addressing. But overall I think our system will work better than a system run by the goverment.

Clearly, some people have no idea how much of our current healthcare system is run by the government in one capacity or another . . . and it's not just the poorly functioning aspects that are government run.

Yes, but most of the time the private sector is able to do things better than the goverment.

 

[BaliBabyDoc]

Give me some examples in healthcare . . . if you don't mind.

 

[charrison]

Originally posted by: BaliBabyDoc
Give me some examples in healthcare . . . if you don't mind.

Well just recently I was referred to an orthepedic doc. I was examined in a timely manner by this doctor, who ordered a CT scan. The CT scan was schedule for the next day. The doc did say the CT was probably not needed, but he wanted to be sure of the diagnoses before he is going to perform surgery on me. I declined to have the surgery the day after the CT scan and will probably have it done next week. Total time from start to finish is going to be about 3 weeks, with a 1 week delay on my part.


At this point I am pretty satisfied with the level of service i am receiving from the private industry.
Now compare this to where goverments run all the medical facilities.


Hopefully in about 6 weeks i will resume the running i have not been able to do the past couple of months.

 

[ReiAyanami]

maybe Canada uses a universal Darwin system, if u can survive the wait long enuff, u deserve to survive...

 

[heartsurgeon]

Best evidence is that few people actually need imaging but it is still considered part of the standard of care. If we did not have CT scan we would spend far less in the treatment of meningitis but the quality of care would be minimally affected for the vast majority of patients.

as a physician, your duty and legal obligation is to provide the best care possible for the individual you are taking care of. i assume that those few patients who needed a ct scan and didn't get it, they would suffer from brain herniation and death....

we routinely screen for all sorts of things in patients that are uncommon, but catastrophic if missed. that's called modern medicine.
oh yes, and if don't practice modern medicine (or the standard of care as you call it), i'm sure an malpractice attorney will be contacting you.

allocation of health care dollars and resources is a societal and political issue. as a physician, it's always important to be efficient and not wasteful in the utilization of hospital resources, however, your overarching duty is always to the patient.

 

[BaliBabyDoc]

Yes, but most of the time the private sector is able to do things better than the goverment.

Your anecdote does not satisfy any criteria of better other than to say it was performed in a timely fashion according to you.

My mother had employer provided healthcare. She was generally healthy with the notable exception of being overweight. She developed indigestion and was prescribed a H2 antagonist (commonly called an acid blocker not to be confused with more expensive proton pump inhibitors like omeprazole). After several months she continued to complain about indigestion plus abdominal pain. Her physician suggested it was emotional stress from an impending divorce so he prescribed an antidepressant (setraline) along with a proton pump inhibitor (bump up to the omeprazole). After several more months past, she returned to her primary care physician with unremitting symptoms. After bothering to do a sufficient physical exam he discovered a palpable abdominal mass. X-rays confirmed the mass and followup CT revealed a basketball-sized abdominal mass extending from the right renal pole (top of kidney) anterior/superior the stomach and encircling the distal (lower aspect) portion of the esophagus(looks like we found the cause of her indigestion).

I accompanied her for the surgical consultation (at the time I was a 1st year MD/PhD student), in words that will haunt me forever . . . her arsehole surgeon had the gall to say, "This mass looks to be manageable and centrally-necrotic by CT. If I can't handle it I will give you all the money in my bank account." He could have kept the money, unfortunately he wasn't right.

After her two month recovery from totally unsuccessful surgery, we went through consultations with oncology at UNC (publicly-funded institution). I skipped school to take her to the National Cancer Institute (NCI) in Bethesda. After two months of chemotherapy it became readily apparent we were not going to prevail.

That was over four years ago. During my med school years I learned that centrally-necrotic masses often means a tumor is growing beyond it's blood supply (which is an indicator of rapid growth . . . typically not good).

Technology merely augments the diagnostic power of physicians. Sometimes it does provide new interventions in the form of medications or procedures. But the best physicians are great before you apply the technology. The technology makes them better. For weaker physicians, the technology is an expensive bandaid for inadequate education/ability.

There's no guarantee a good diagnostician would have changed the outcome but the 50 patient/day census and medical model of treating symptoms with the handiest medication did not help. The access to advanced imaging modalities (including MRI after diagnosis) clearly had no effect other than making pretty (from a scientists perspective) and expensive pictures. Even your example it apparently did not change the outcome.

So I just exemplified the power of anecdote in demonstrating that private healthcare can do an abominable job and then public entities can confirm how little can be done for some conditions.

So I ask again, what evidence do you have that private companies can (and will) do a better job delivering healthcare than the government. I know some examples but clearly it's not enough to convince me. Let's see what you've got.

 

[glenn1]

So I ask again, what evidence do you have that private companies can (and will) do a better job delivering healthcare than the government.

The burden of proof isn't on those wanting to keep the status quo, it's on those who want to change it. The side that wants all this socialized medicine is going to have to convince the rest of us why we should put all your gee-whiz ideas into place, those who oppose it have no such obligation in turn, since that's the current default position.

 

[BaliBabyDoc]

It's not the default. If you have good insurance and live in a resource-rich area you are indeed happy with the status quo. Curiously, the majority of national surveys reveal:

1) Most Americans want broad reforms in healthcare.
2) Most Medicaid recipients are happy with Medicaid.
3) Most physicians are NOT happy with Medicaid . . . in fact they often refuse to take new patients and are pruning their current patient roster.
4) Most Medicare recipients are happy with Medicare.
5) Most physicians are NOT happy with Medicare . . . see #3.
6) Most physicians are NOT happy with private insurance reimbursement or bureaucracy.

What you call "pie in the sky" I call addressing inequities while producing a sustainable system of care. The current system is not sustainable.

The do-nothing/no radical change crowd thinks it's perfectly reasonable that intergenerational income redistribution (Medicare/FICA) funnel billions of dollars each year into funding for major medical centers where many "contributors" cannot get services rendered b/c they don't have acceptable insurance or have no insurance. They think it's perfectly acceptable for hospitals to charge patients without insurance (many of which do attempt to pay their bills) MORE than insured patients b/c the insured patient's plan has negotiated fixed (often artificially low) prices for service rendered.

Ask someone with Stanford Medical Center or UCSF how market forces can bring you to the brink of merger for no reason other than trying to capture "economies of scale".

Assuming you believe that medical technology is on a Moore's Law type of clip . . . the cost of providing those services appears to be on a equally steep curve. How long can it go on? And before you hit the tort angle . . . not even the simplest mind in healthcare economics believes current healthcare cost inflation is due primarily to medmal.