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Public Health Care Inefficiency

Wanted to post this yesterday, but the server was down.

I’m all for voting and all. The results were surprising to me, especially the complete collapse of the Liberals and Bloc Quebecois. But DAAAAAAAAAAMN, lines were long. Elections Canada really has to hire more efficient staff. There were people sitting around doing NOTHING, while only two people were registering over 50+ voters.

It certainly makes me think of the efficiency of private vs public sector. In the private sector, wastes or inefficiencies are removed sooner because they cut into the bottom line. Health care is no different. There are inefficiencies in the hospital system and health administration. A little privatization and competition would definitely reduce unnecessary services, but a lot of people balk at the idea of privatization of health care.

I’m not arguing for the complete privatization like the States. I just think some incentives (whether positive or negative) would be beneficial to the whole health care system. A recent article from the Globe and Mail discusses the way doctors are paid. The comments are quite interesting to read too. Personally I disagree with the problem being how doctors are paid. The problem isn’t Fee For Service (FFS) vs Salary. In fact, FFS can often increase inefficiency and decrease wait times. It doesn’t take a genius to know that billings by physicians will increase if you increase the number of physicians.

The bigger problem is the lack of priority in preventative medicine and family medicine. We need to put incentives on the right type of medical care . Too much money is spent on high-acuity cases that could have been prevented and clogged up hospitals by patients waiting to be placed in homes. Too much money on hot-shot CEO’s who have grand ideas of cutting costs but no experience with real patient care. Persistent families wanting to keep their 90 year old grandpa with multiple strokes and co-morbidities on life support in the ICU with unrealistic expectations.

We can’t go on this way, eventually things will change. Perhaps one day there will be a two-tier system, lots of other countries have done this successfully. Whatever the outcome, I’ll be actively following it.

I never used to think too much about health care costs and delivery. Growing up, I wanted to be a doctor to help sick people and cure diseases. But as you get to know more of  “the system” it becomes more evident how much our health is affected by the systems we create. From ER wait times to delays in surgeries, the organization of our health care is as important to the ultimate care of patients as the treatments we deliver. So I encourage anyone interested in a career of medicine to be informed about these issues. It may seem far removed from your day to day schooling, but one day you’ll be grappling with the system and maybe even changing it.

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  1. medrunner
    medrunner May 4, 2011

    Well spoken med,
    We are clearly on the same page… I was going to comment on that article in my next post. Instead, I’ll have to link to your blog and say- “what he said”

  2. medmary
    medmary May 30, 2011

    i’m an orthopedics RN of 5 years in BC , Canada….many of my colleagues wish the surgeons would hold the surgery on a morbidly obese patient of 300+ pounds until they lose weight and attend mandatory classes to strengthen the upper body so they have the arm strength and core muscles to push themselves upright in bed…many are so deconditioned and ultimately slow to mobilize…thus ending up with PEs/MIs/aspiration pneumonia/GI bleeds within 72 hours which increases the workplace injuries to health staff because we have to use bedpans and assist them to stand at the bedside to use commodes or encourage to ambulate to BR….why do we do hip/ knee replacements on individuals who are so deconditioned that they typically obese and have obstructive sleep apnea hx…it goes on and on….we have pre cllinics to prepare for the surgery but no fitness or wt loss expectations where the pt must prove in a F/U appt prior to Sx that these expectations have been met , thus the Sx can go as scheduled….i’ve watched a pt pop open a bag of mini chocolate brownies to eat the day after hip Sx!!!

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