Audience Comment / Edmonton Town Hall
Well good evening. My name is Dianne Dyer. I'm the President Elect for the College and Association for Registered Nurses here in Alberta. I first of all want to thank CMA and I certainly want to thank Maclean's for hosting this tonight. It's just a wonderful event.
When we talk about good value in healthcare this I think means that people receive the care they need when they need it from the right provider.
Our population is aging rapidly and there is a growing burden of chronic illness which is really taxing our healthcare system. There are new drug therapies, new technologies and shorter hospital stays meaning that people are receiving more care in community settings. "Do they receive the care they need when they need it?" is really the question. When we need a healthcare system we ask ourselves: "Are we getting equal value on the areas of health promotion and treatment of chronic illness?" Effective treatment by interdisciplinary primary care and primary healthcare teams in the community can help people avoid expensive care in hospitals.
In order for a team-based care model to be effective however, in terms of service delivery and cost, we need to remove the barriers and the unnecessary steps to seeing the right provider. Patients (or clients) must have access to services when they need them and access to all members of the interdisciplinary team in order to make decisions about their care and their treatment. We cannot expect the patients, the clients, to make decisions, be responsible for their health, if we don't provide them the education and the supports that they need.
Now a national pharmcare program would also contribute to chronic disease management in communities. Since medicare began it's costs have remained stable while the costs of prescription drugs have soared. Prescription drugs are a major driver of healthcare costs. Canada's per captita drug costs are higher...
Ken McQueen: Stops Dianne Dyer from continuuing: "Can we keep this short please because we've got alot of people to get through." [Editor's note: Please see Michael McBain's comment from the Toronto Panel which completes thought and also read this media release from the College & Association of Registered Nurses of Alberta]
Dianne Dyer: Sure. Ok. And then from a long-term point of view we need to remember that we promote health, injury prevention, illness prevention in the community to minimize the severity of the chronic illness and disabilities in later life. Stops the audience member from continuuing: "Can we keep this short please because we've got alot of people to get through." [Editor's note: Please see this audience member's comment from the Toronto Panel which completes thought].
Sunday, April 10, 2011
Saturday, March 19, 2011
TTH-2
Audience Comment / Toronto Town Hall
Hi there. My name is Jeremy Petch. I live here in Toronto.
"Good Value"... (and there's alot of ways to answer that) but I'll speak right to the idea of just not treating things through the healthcare system that are better addressed elsewhere. And this is to go to the point of the social determinants of health and the importance of including that is that in many cases we treat the healthcare system has become the sort of end point for all kinds of social problems...be there lack of social housing, lack of good quality food...nutritious food... These kinds of things are ultimately dealt with in the healthcare system.
I'll use one example (who I'll refer to as "Betty") who came into TGH [editor's note: Toronto General Hospital] with abdominal pains. She was on welfare. All she could afford to eat was white rice and she came in with an abdominal blockage so severe it needed to be dealt with through a really quite radical surgery. It cost more to perform that operation than it would have cost to feed Betty good, nutritious vegetables for 20 years. Alright? We way over-payed for that.
And I think Dr. Turnbull since you work in inner-city health you probably see this all the time. (Turnbull nods agreement). That is the place. Right? We also see it on our aborginal reserves where aborginal populations have enourmous health problems and it's the social determinants of health that are really driving those.
So I think if you want to call for federal leadership one of the places the Feds can really take a strong role is in addressing the social determinants of health across the country. And that will take alot of pressure from organizations like the CMA to fight against what I've seen in federal health policy... a tendency amongst the conservative government to not recognize it. Perhaps they see the social determinants of health as Liberal wish fulfillment because they offer a rationalle for paying for programs that are traditionally liberal. But the social determinants of health are real. The epidemiology is there. And the best way to address...one of the ways to get good value from our healthcare system is to address them because it's cheaper to deal with the social determinants than to address it with expensive abdominal surgery...And whatever else. Thank-you.
Dr. Haddad responded:
Certainly on the social determinants of health... I mean I mentioned that in my statement... I run a hospital. When you look at patients that come into hospital that shouldn't be there. I see children -- the reference was to adults -- there are many, many people who use our system today that shouldn't have to use the system. So I think that the last speaker really challenges us on a national level to deal with policy around this but also the recognition that there's a direct correlation to costs in the healthcare system.
Hi there. My name is Jeremy Petch. I live here in Toronto.
"Good Value"... (and there's alot of ways to answer that) but I'll speak right to the idea of just not treating things through the healthcare system that are better addressed elsewhere. And this is to go to the point of the social determinants of health and the importance of including that is that in many cases we treat the healthcare system has become the sort of end point for all kinds of social problems...be there lack of social housing, lack of good quality food...nutritious food... These kinds of things are ultimately dealt with in the healthcare system.
I'll use one example (who I'll refer to as "Betty") who came into TGH [editor's note: Toronto General Hospital] with abdominal pains. She was on welfare. All she could afford to eat was white rice and she came in with an abdominal blockage so severe it needed to be dealt with through a really quite radical surgery. It cost more to perform that operation than it would have cost to feed Betty good, nutritious vegetables for 20 years. Alright? We way over-payed for that.
And I think Dr. Turnbull since you work in inner-city health you probably see this all the time. (Turnbull nods agreement). That is the place. Right? We also see it on our aborginal reserves where aborginal populations have enourmous health problems and it's the social determinants of health that are really driving those.
So I think if you want to call for federal leadership one of the places the Feds can really take a strong role is in addressing the social determinants of health across the country. And that will take alot of pressure from organizations like the CMA to fight against what I've seen in federal health policy... a tendency amongst the conservative government to not recognize it. Perhaps they see the social determinants of health as Liberal wish fulfillment because they offer a rationalle for paying for programs that are traditionally liberal. But the social determinants of health are real. The epidemiology is there. And the best way to address...one of the ways to get good value from our healthcare system is to address them because it's cheaper to deal with the social determinants than to address it with expensive abdominal surgery...And whatever else. Thank-you.
Dr. Haddad responded:
Certainly on the social determinants of health... I mean I mentioned that in my statement... I run a hospital. When you look at patients that come into hospital that shouldn't be there. I see children -- the reference was to adults -- there are many, many people who use our system today that shouldn't have to use the system. So I think that the last speaker really challenges us on a national level to deal with policy around this but also the recognition that there's a direct correlation to costs in the healthcare system.
Monday, March 7, 2011
TTH-1
Audience Comment / Toronto Town Hall
My name is Michael McBain. I'd like to start just by thanking Dr. Turnbull and The Canadian Medical Association for calling on federal leadership in healthcare. We're gonna lose the system without federal leadership. We're not just a bunch of provinces. We're not just a bunch of regions. We're a country and the system is splintering because there's no guardianship -- there's no building for the future -- without federal leadership.
You're asking a really good question. We're not getting value for money and I think the 800 lb gorilla in the system is the pharmaceutical industry. Now it's interesting that nobody talks about that but that's the biggest cost driver. How can you say you're concerned about sustainability and rising costs and not address what the cost driver is -- the primary cost driver. Pharmaceuticals has gone up 73% in 10 years per capita inflation adjusted. Nothing comes near that. But worse than that we're spending 30% more than the international average on new drugs. We're not using them properly. Over prescribed. Drugs are dispensed based on marketing tactics not on evidence. Even with children! If we're concerned about children's health we should be concerned about physicians who are prescribing dangerous anti-psychotics to 2 year olds. That's a huge problem and that's a marketing problem. That's something the medical association needs to consider. This is a moral issue. Medicine's not about commercial marketing. And that's the biggest challenge in terms of value for money.
And I think the solution is a universal public pharmacare plan. Not a private plan, not a hybrid like Quebec has because Quebec's drug plan is out of control. It cannot control it's costs because it partnered with the private insurance industry. You have to have a public plan. So I think it's a very good question. I think we have to address the cost drivers and I think we're not getting value for money, particularly with new drugs.
My name is Michael McBain. I'd like to start just by thanking Dr. Turnbull and The Canadian Medical Association for calling on federal leadership in healthcare. We're gonna lose the system without federal leadership. We're not just a bunch of provinces. We're not just a bunch of regions. We're a country and the system is splintering because there's no guardianship -- there's no building for the future -- without federal leadership.
You're asking a really good question. We're not getting value for money and I think the 800 lb gorilla in the system is the pharmaceutical industry. Now it's interesting that nobody talks about that but that's the biggest cost driver. How can you say you're concerned about sustainability and rising costs and not address what the cost driver is -- the primary cost driver. Pharmaceuticals has gone up 73% in 10 years per capita inflation adjusted. Nothing comes near that. But worse than that we're spending 30% more than the international average on new drugs. We're not using them properly. Over prescribed. Drugs are dispensed based on marketing tactics not on evidence. Even with children! If we're concerned about children's health we should be concerned about physicians who are prescribing dangerous anti-psychotics to 2 year olds. That's a huge problem and that's a marketing problem. That's something the medical association needs to consider. This is a moral issue. Medicine's not about commercial marketing. And that's the biggest challenge in terms of value for money.
And I think the solution is a universal public pharmacare plan. Not a private plan, not a hybrid like Quebec has because Quebec's drug plan is out of control. It cannot control it's costs because it partnered with the private insurance industry. You have to have a public plan. So I think it's a very good question. I think we have to address the cost drivers and I think we're not getting value for money, particularly with new drugs.
Sunday, January 16, 2011
MM1-4
"Canada's Leading Health Care Professionals" ... the entire panel with the exception of the journalists is made up of physicians. Where is the representation from the rest of the health care team? No one to represent the viewpoint of nurses or the other front-line workers, many of whom have some excellent ideas on how to make the system more efficient and affordable. I am not sure if you are aware of it but university-trained nurses have the highest averages coming into university of any faculty. They are an intelligent bunch. They work for a salary so they have nothing to gain if the system changes and they are given more responsiblity (vs many physicians who work on a fee for service basis). They are a real bargain at $40.00/hr. if the system would just utilize them to their potential.
http://www2.macleans.ca/2011/01/14/in-conversation-with-macleans-health-series/#IDComment121738732
http://www2.macleans.ca/2011/01/14/in-conversation-with-macleans-health-series/#IDComment121738732
MM1-3
I would hardly call this panel of Nova Scotian healthcare professionals "Canada's *Leading* Healthcare Professionals". The most competent and well-versed voices work in Toronto and are members of the Ontario College of Physicians and Surgeons. It's here -- in Toronto -- that the lion's share of healthcare policy is made for the greatest population of Canadians. Quebec, BC and Alberta are close seconds. Then there's Nova Scotia and the Maritime provinces. Thus the "Nationalist" characterization of this debate is suspect. It's well known that Nova Scotia has a rather politically complacent population in respect of their use of healthcare services and are VERY ACCEPTING of outdated paternalistic models for clinical care. Just look at Dr. Jane Brooks page at Doctors Nova Scotia informing the public about their Medical Records. Then go to Ontario's CPSO site on the same topic. The citizens of Nova Scotia accept this appalling secrecy and further they submit to barriers to abortion service that other Canadian women wouldn't. Any model proposed by this group will not be AT ALL reflective of the current values shared by the majority of Canadians.
http://www2.macleans.ca/2011/01/14/in-conversation-with-macleans-health-series/#IDComment121690695
http://www2.macleans.ca/2011/01/14/in-conversation-with-macleans-health-series/#IDComment121690695
Saturday, January 15, 2011
MM1-2
There are better models for health care which combine private and public successfully; Australia and Scandinavian countries. In World health care they are always ahead of us when it comes to efficiency, delivery, and overall ranking. It's time for us to stop this tunnel vision and take a look at better ways on how to deliver health care timely and efficiently. As the cost of diagnostic tools and treatments are rising, our current model of health care are unsustainable.
http://www2.macleans.ca/2011/01/14/in-conversation-with-macleans-health-series/#IDComment121533454
http://www2.macleans.ca/2011/01/14/in-conversation-with-macleans-health-series/#IDComment121533454
MM1-1
I wish that this discussion would be really about improving Medicare but unfortunately it is all about privatizing it like the USA model. Medicare needs more funding, more professionals and we can affort it because we have higher taxes in Canada for this purpose. Instead of spending millions buying flight jets, look after heath and education. We don't need weapons, we need more MRI machines, more update hospitals. All my americans friends envy our system and they would love to have it implemented in USA. If people has the money and wish to pay extra to private clinics, they are welcome to cross the border and do so.
http://www2.macleans.ca/2011/01/14/in-conversation-with-macleans-health-series/#IDComment121533454
http://www2.macleans.ca/2011/01/14/in-conversation-with-macleans-health-series/#IDComment121533454
Monday, January 10, 2011
GM1-14
For starters I would make doctors and all health care workers provincial employees .
I would open more room at medical schools.
I would allow nurses and trained specialists to do more of the work under a doctors guidance.
I would get rid of most of the non productive staff or reduce their salaries.
I would open more room at medical schools.
I would allow nurses and trained specialists to do more of the work under a doctors guidance.
I would get rid of most of the non productive staff or reduce their salaries.
Tuesday, December 21, 2010
GM1-12
In reply to Metasphere http://cmatalks.blogspot.com/2010/12/gm1-10.html
I don't believe that physicians do not want to see more physicians trained. However, there are gluts in some specialties and shortages in others. We are short of family doctors and so there should be family medicine programs whereby the entrants become family doctors. The University of Calgary is piloting just such a program.
http://sitelife.theglobeandmail.com/ver1.0/gocomm?ck=CommentKey%3a9390ef97-278f-4fb1-80f4-2dd141c2fb83
http://sitelife.theglobeandmail.com/ver1.0/gocomm?ck=CommentKey%3a9390ef97-278f-4fb1-80f4-2dd141c2fb83
GM1-11
In reply to Metasphere http://cmatalks.blogspot.com/2010/12/gm1-10.html
I would agree with that but there has to be a certain acceptance criteria that a percentage of those new applicants will move to reomote, or rural areas that are sorely lacking in family doctors. Most new docs want to stay in heavily populated urban areas.
There's a doctor shortage crisis in non-urban areas of Canada.
There's a doctor shortage crisis in non-urban areas of Canada.
GM1-10
One thing I would do is triple med school enrollments.
But the doctors won't want to hear that.
But the doctors won't want to hear that.
GM1-9
In reply to Ledavid http://cmatalks.blogspot.com/2010/12/gm1-8.html
To say baby boomers are waiting behind new immigrants without any proof or knowledge of the medical conditions at issue is irresponsible.
If you are accepted by the gov't into this country and become a Canadian, you get medical care. Period. Doctors treat all Canadians based on whose condition is the most urgent.
If you are accepted by the gov't into this country and become a Canadian, you get medical care. Period. Doctors treat all Canadians based on whose condition is the most urgent.
GM1-8
We forget health care in Canada is supposed to be PUBLIC health INSURANCE. Meaning everyone pays a 'premium' through their taxes. So you have baby boomers, who have paid the premium all their lives, on waiting lists behind immigrants who just arrived and have paid nothing. That's a de facto reverse head tax.
GM1-7
In reply to Blagger http://cmatalks.blogspot.com/2010/12/gm1-6.html
Not only reduce their salaries but reduce the positions! In a lot of cases, there are just too many administrative jobs that could be cut back on.
In regards to that, I sometimes wonder if instead of letting the provinces control health care, the federal gov't should. I'd like to think that this would reduce a lot of paper work and bureaucracy. Also this way it wouldn't matter if you were from BC and visiting ON and needed to see a doctor.
As Canadians we should have health care in all of Canada without red tape.
In regards to that, I sometimes wonder if instead of letting the provinces control health care, the federal gov't should. I'd like to think that this would reduce a lot of paper work and bureaucracy. Also this way it wouldn't matter if you were from BC and visiting ON and needed to see a doctor.
As Canadians we should have health care in all of Canada without red tape.
GM1-6
Another improvement would be to reduce the obscene salaries of the executives and board members in the healthcare system, and put that money towards frontline staff and services. Also, there needs to be more accountability with heathcare boards and foundations in general. They are out of control.
GM1-4
In reply to Healthcare Insider http://cmatalks.blogspot.com/2010/12/gm1-3.html
@Healthcare Insider
Agreed that certain considerations need to be made to ensure proper care ... but yours is not the best analogy because the mechanic treats the cause while the doctor treats the symptom.
Agreed that certain considerations need to be made to ensure proper care ... but yours is not the best analogy because the mechanic treats the cause while the doctor treats the symptom.
GM1-3
In reply to Elder Gonzo http://cmatalks.blogspot.com/2010/12/gm1-1.html
http://sitelife.theglobeandmail.com/ver1.0/gocomm?ck=CommentKey%3a0337dfa0-7a8f-4d95-8fd0-6db161425fd6
At first glance this might seem like a great suggestion. However, in Alberta where I am from it is unlawful for a physician or pharmacist to fill a prescription for more than 18 months without the patient being re-assessed by a physician to see if the patient is still on the right medication at the right dosage for the right reasons. Now, given that the majority of us get our cars checked out at at least yearly intervals, I do not think it is unwise to go to the doctor and have him ensure we should still be on the same blood pressure medication at the same dosage. It would negligent for him/her to call in a prescription to the pharmacy without even laying eyes on you. Would you let your mechanic order parts for your car without checking it out?
http://sitelife.theglobeandmail.com/ver1.0/gocomm?ck=CommentKey%3a0337dfa0-7a8f-4d95-8fd0-6db161425fd6
GM1-2
In reply to Elder Gonzo http://cmatalks.blogspot.com/2010/12/gm1-1.html
FANTASTIC idea. I don't know why this wasn't suggested before. I try to avoid the doctor if possible.... but when I had to go for about 10 months or so, I had to make "refill" appointments far too often...
Wasted my time: I had to take time off work, reduces PRODUCTIVITY
Wasted my money: Why should my tax dollars be wasted on meaningless visits like this when I should be able to get a refill from the pharmacy?
Wasted my time: I had to take time off work, reduces PRODUCTIVITY
Wasted my money: Why should my tax dollars be wasted on meaningless visits like this when I should be able to get a refill from the pharmacy?
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