You guys from Canada are beating us.....Geeeez ! Look at this...

[IslandTractor]

I believe when it comes to my health care....there are only two people that should be involved....My Doctor and Me...that is it...I pay insurance premiums for coverage and even if on Medicare...the health decisions should be yours and your doctors...no one else....and that's all I have to say about that....Life is like a box of candy....ya never know what you are going to get....

If it were only that simple. The patient and doctor are indeed the ones who have to transact the most important business but there are very legitimate "others" involved and it is impossible to manage any system without outside influences. For example, there is not only your doctor but your doctor's licensing and continuing medical education. Licensure and monitoring CME end up being state functions. There is the payor (insurance, medicare etc) who simply has to have some standards (who would stop a doc from charging excessively or doing unnecessary or out of date procedures). Everyone loves to think that their doctor is the best in the world but anyone can see that is impossible and that there are some very good, some very bad and most are solidly in the middle just as with any other profession or trade. The desirable goal IMO is to accomplish the necessary standards checking etc in the least intrusive way possible while ensuring a reasonable degree of quality assurance. Think pilot and commercial airliner as an analogy. You don't want a committee to fly the plane but you also want to insure that the pilot is well trained and experienced. The trouble with medicine/healthcare is that the decision points are not as clear cut as with who can fly a plane and when they can take off or what altitude they can fly. Human biology is more complex and therefore less able to be neatly categorized as with FAA rules etc.

 

[CinderSchnauzer]

Our system is a lot of things....but EFFICIENT is NOT one of them. There is a lot of waste in our system. Waaayyy too much bureaucracy and overhead. When a province is spending almost half of their entire budget on health care, there is a problem with how it is being run.

You could be right regarding the Alberta system. While admittedly an Ontario study, you may find some interesting comparative information in this report

http://www.web.net/ohc/first-do-no-harm-pre-drummond-report-final.pdf

The percentage of budget can be used a a red herring sometimes if one does not delve into the details. Some years ago Ontario health spending was (pick a number) 35% of the budget. Then the province downloaded a bunch of social service costs to the municipalities, with basically no shift of revenue. All of a sudden - overnight - healthcare spending was (pick a number) 45% of the budget. Nothing changed as far as actual spending, just the denominator used to determine %.

Again, to determine where inefficiency may lie, there are approximately four major components to healthcare spending. Acute Care hospital budgets, Chronic Care, Physician payments and Pharmaceuticals.

It is always easy to suggest there are too many managers and administrators in the healthcare field. Even relatively small community hospitals have annual operating budgets in the 100 million range and employ from 800 - 1500 people depending on the mix of full time / part time. A community teaching hospital can easily have a budget in the range of $500 million. One cannot simply fire all the managers / administrators and expect a modern hospital to function. In fact, there are studies that suggest a hospital is one of the most complex organizations to operate. Efficiency and access to service is not necessarily the same thing.

 

[Mousefield]

This is why some of the health care cost keeps spiraling out of control. Most of us can only dream of having the following as vacation time. This from the Vancouver Island Heath Authority. So after 19 years of working for VIHA you get 35 work days or 7 weeks paid vaction, nice of us taxpayers to be so generous.

Vacation entitlement accrues between July 1 and June 30 of the following year (i.e., July 1, 2011 - June 30, 2012). Vacation accrued within this period must be used in the calendar year where credits are accrued.
Regular, Temporary and Term Specific employees are eligible for annual vacation entitlements as follows:
Employees are eligible for annual vacation entitlements as follows:
one to four years’ continuous service — 20 work days’ vacation
five years’ continuous service — 21 work days’ vacation
six years’ continuous service — 22 work days’ vacation
seven years’ continuous service — 23 work days’ vacation
eight years’ continuous service — 24 work days’ vacation
nine years’ continuous service — 25 work days’ vacation
ten years’ continuous service — 26 work days’ vacation
eleven years’ continuous service — 27 work days’ vacation
twelve years’ continuous service — 28 work days’ vacation
thirteen years’ continuous service — 29 work days’ vacation
fourteen years’ continuous service — 30 work days’ vacation VIHA Terms & Conditions of Employment – Non-Contract Employees August 2, 2011 Page 24 of 25
VIHA Terms & Conditions of Employment – Non-Contract Employees August 2, 2011 Page 25 of 25
fifteen years’ continuous service — 31 work days’ vacation
sixteen years’ continuous service — 32 work days’ vacation
seventeen years’ continuous service — 33 work days’ vacation
eighteen years’ continuous service — 34 work days’ vacation
nineteen years’ continuous service — 35 work days’ vacation

 

[3930dave]

Agreed Cinder, a hospital is a very complex environment to manage. I have some insider exposure, my mother was an RN all her working life.

#'s can be hard to keep as an apples/apples comparison, as your above example illustrates. Some trends can be a little startling, if the #'s do actually track properly. There was an article in the Toronto Sun within the last 3 months - I don't recall the exact #'s, but over a period of something like 6 years, the head count for Hospital managers in Quebec went from something like 5,000 to over 10,000.

I went poking around just now to see if I could find the article, no luck. Basically a 100% increase in staffing, in less than a decade. Maybe some jobs got redefined (mgmt vs. labour) over that time, and maybe there are some other explanations, but even so, that is a pretty big jump. Where that gets tough to swallow is for those of us trying to stay employed in the general private sector - middle management and lower-upper management there has often been eliminated or tasked with supervising many more workers.

Different issue, but some structural problems need to be fixed, at least in Ontario. Keeping paramedics tied up sitting in Emergency with a patient is just a bandaid solution, pun intended. And, this paramedic scenario tends to add credence to the argument that hospitals need more workers/beds - if that means less managers (not zero), then perhaps that balance needs to be looked at more closely.

It is too bad the funding challenges are as big as they are.

Rgds, D.

 

[CinderSchnauzer]

#'s can be hard to keep as an apples/apples comparison, as your above example illustrates. Some trends can be a little startling, if the #'s do actually track properly. There was an article in the Toronto Sun within the last 3 months - I don't recall the exact #'s, but over a period of something like 6 years, the head count for Hospital managers in Quebec went from something like 5,000 to over 10,000.

Different issue, but some structural problems need to be fixed, at least in Ontario. Keeping paramedics tied up sitting in Emergency with a patient is just a bandaid solution, pun intended. And, this paramedic scenario tends to add credence to the argument that hospitals need more workers/beds - if that means less managers (not zero), then perhaps that balance needs to be looked at more closely.

Rgds, D.

I have no direct knowledge of what goes on in PQ, however, rest assured "management" did not double in Ontario in the last 20 years. In fact, almost annually when planning for the upcoming budget year it was a case of - who can we fire - what program or service can be eliminated, how can we do something with less resources and last but not least how many beds do we need to close to balance the budget. Managers / programs were eliminated entirely. Managers were given greater span of control - looked after multiple departments. When that well ran dry the next step, in multiple hospital towns was total consolidation of one or more hospitals or at the least specialization of services. One hospital did Obstetrics, one did Trauma, one specialized in Orthopedics - in some cases only one Emergency etc etc. Managers were eliminated and those left were required to serve either two hospital corporations or manage at multiple sites. Presidents / CEO's became responsible for multiple sites.

A lot of things have changed, some for the better, some not. Family Physicians have for the most part resigned their hospital privileges - too much time and effort to drop by the hospital to see their patients compared for the financial remuneration. A lot have formed group practices and basically sit in their office, seeing patients from 8-4 or whatever. After office hours the answering machine basically says - "if you have a problem - go to Emerg". Often if you want to talk about more than one thing another appointment is required. For anything much more complicated than a sniffle, you will be referred to a Specialist. Sometimes this can be a good thing - if the patient can actually get an appointment in a timely fashion.

To deal with hospital inpatients, since the FP no longer comes in to see them, hospitals have had to actually hire physicians - often referred to as "Hospitalists" to provide the required in hospital care.

The thing with Paramedics waiting relates to a "transfer of care" issue. They can't just drive up, dump the patient onto an ER stretcher and drive off. ER's like a fire department require a minimum level of staff to open the doors, but after that the worst case will get first priority. Potentially staff can be called in for a disaster, but in many cases the solution is that less serious cases just wait until the ER Physician is available. If the ER Doc and RN's are too busy with a particular case(s) this transfer of care does not take place in a speedy fashion. ER Physicians often now represent a specialization. The days of the local FP doing a few shifts in ER are pretty well history. In many cases they have banded together and contract with hospitals to proved agreed levels of ER Physician staffing. In ON they bill OHIP for services rendered, however, if ER billed volume does not reach contracted levels, hospitals pay the difference.

Another "inefficiency" to a large extent related to GOV funding, or lack thereof, is when elderly patients are admitted for procedures, but when completed they are unable to return home and there are no beds available in the Chronic Care system. The hospital cannot discharge them without a place to go and as a result they become "bed blockers" taking up a bed that could otherwise be used to admit another acute care patient - perhaps one that has been camping in ER waiting for a bed to become available. As the population ages, unless additional Chronic Care facilities are built and funded this problem will only get worse. In a simplistic way, bed blockers can actually be good for business, since on the whole they usually require less resources than someone who is sicker.

Anyway, in my opinion, that was a long way to say that if every single "manager" was fired and somehow staff could totally look after themselves, savings would be minimal in relation to total healthcare expenditures.

 

[Brushhill dave]

I pay health care premium here in Alberta, be directly or iindirectly and I don't care. Last week my family got to( regrettably) use the health care system here in alberta and I was thourghly impressed. She required pins to be put in her arm and within 30 hours of it being requested by our family doctor( south african) it was complete. Now as far as I am concerned that was worth the huge amount of tax dollars I pay every year, our immigration system is no different than any other... There will always be loopholes and those that can find them and take advantage. Our family doctor from south Africa is one of the finest doctors I have ever met and is an excellent member of the community as well are his peers. They in my mind are what immigration is about. These no good criminal bastards that find their way in should be exported faster than they arrive. The Americans have a plane that leaves every 2 days to el Salvador full of returnees. Our Canadian plane should be headed to Sudan, somilia and the anywhere else these criminal bastards come from. If you are of no use to Canadian society than beat it! If you have come here to better yourself and the life
Of your family in a legimitate way than welcome how can I help? Whoa kinda got off on a tangent there

 

[Willl]

Didn't realize I was in a race. What's in the pot ?

 

[Mounted Madness]

For anyone interested in reading it, here's a Canadian perspective as it relates to the article that made such a bold suggestion.
Based on this well known (in Canada) columnists commentary, he just dumped a whole salt shaker of salt on the financial statement that we are so far ahead of our American cousins.
Here's the link if you're interested...

Our 'wealth' isn't all it's cracked up to be - Winnipeg Free Press

 

[scaredychicken]

what can I say ? I live in Canada, have a job, a mortgage, couple of loans, modest home, 3 teenagers, medical bills etc, its crazy cold and deep snow in the winter, mostly great in the summer - typical Canadian circs I think. I also spent 2 years of university living in Michigan, honeymooned in Vegas - er, umh, Oregon. I still have a number of friends in Michigan (not as cold, but deeper snow), New Jersey, New York, Illinois, California ... I love visiting friends in the States. Yes, I spend most of my loonies, and save for the toys (or tractors, or model railroader necessities). That's about it, eh.

 

[CinderSchnauzer]

For anyone interested in reading it, here's a Canadian perspective as it relates to the article that made such a bold suggestion.
Based on this well known (in Canada) columnists commentary, he just dumped a whole salt shaker of salt on the financial statement that we are so far ahead of our American cousins.
Here's the link if you're interested...

Our 'wealth' isn't all it's cracked up to be - Winnipeg Free Press

No one ever claimed a Reporter / Journalist would let a few facts get in the way of a good story. Canada beats US is always a good play, especially with the home team.

There are those in both US and Canada who are fantastically wealthy and those who don't have two pennies to rub together. Most of us on TBN, I suspect fall somewhere between those two extremes. Wherever we live in North America, when compared to how billions of other people live, I think we are truly blessed.

 

[Mounted Madness]

No one ever claimed a Reporter / Journalist would let a few facts get in the way of a good story. Canada beats US is always a good play, especially with the home team.

There are those in both US and Canada who are fantastically wealthy and those who don't have two pennies to rub together. Most of us on TBN, I suspect fall somewhere between those two extremes. Wherever we live in North America, when compared to how billions of other people live, I think we are truly blessed.

And your statement is one we TOO frequently forget. Thanks for the reminder...:thumbsup:

 

[3930dave]

Cinder - I had some awareness of the efficiencies (for better or worse) being pushed through in Ontario. That is why I found the article concerning Quebec so startling. Wish I could come up with the link to that, if I do I will post it later.

We have a good system here, but there is "a lot" going on behind the curtains. Americans reading this thread will get a glimpse into some of the issues our system struggles with, and some of our regional differences.

It is a big game, with big stakes for everybody. I do recall over the years the various bed count cuts, cuts to nursing funding, and reduced med school enrollment limits. At the same time, our government was allowing high immigration levels, knowing full well that the resident population was aging.

The preceeding paragraph is partly where my "Create a crisis to drive an agenda" comment came from. That we have as well a performing health care system as we do (despite cuts, and "efficiencies") is mostly a testimony to the professionalism of the workers.

Rgds, D.

 

[Lloyd_E]

You guys are still sour about 1812... !

Health Care...

We pay a lot in taxes... to cover some of the costs. Our government, Federal, and including provincial make a lot of mistakes regarding salary increases, admin direction etc.
We have a huge problem retaining Dr's. We also have a world class Medical University here... but the debt load of a graduate is probably $150K or higher and they seek a higher
salary elsewhere to pay it off... wouldn't you?

I have no problem with a two tiered system. If you can pay for it, you free up the wait line for the general public. I have friends that can pay for it and they go stateside - period!

The system is hierarchal. I have experienced it on both sides. Having heart issues three years ago I was whisked in through emerge, hooked up even before they completed the paperwork.
My total cost was just under $100 and that was for a private phone hook up and long distance calls home. The antithesis of this is waiting in emerge for 5+ hours to have stitches in a finger.
And being second last, giving up my position to a young mother with an infant who had been there longer... when the infant only had a cold but no family doctor was available.

I recently had a cat-scan for my back. I told them I would travel half the province... anytime, any day... that gave me about 6 options. Instead of waiting 2-6 months as usual I got in within 3 weeks...
actually two - someone cancelled last minute and that is another issue.

We can all give examples good or bad... the system has it faults. A lot can be fixed if there is a 'want' to fix it. I can give examples of over spending on supplies because it was always done that way
and people/systems don't change.

We have seen tourism killed here after 911 which equates to dollars spent here which equates to possible budget increases to Health Care. We have also seen government assist in killing tourism
with the removal of a link to the US, stoppage of HST reimbursements to the travelling USA citizens and unfounded increases in gas prices!

With the dollar on par we have lost a revenue stream of US citizens buying real estate here and hiring carpenters, tradespeople etc...

We have felt the economy dwindle...

It will be a long road to recovery if it ever happens...

 

[tcreeley]

You guys are still sour about 1812... !

Health Care...

We pay a lot in taxes... to cover some of the costs. Our government, Federal, and including provincial make a lot of mistakes regarding salary increases, admin direction etc.
We have a huge problem retaining Dr's. We also have a world class Medical University here... but the debt load of a graduate is probably $150K or higher and they seek a higher
salary elsewhere to pay it off... wouldn't you?

I have no problem with a two tiered system. If you can pay for it, you free up the wait line for the general public. I have friends that can pay for it and they go stateside - period!

The system is hierarchal. I have experienced it on both sides. Having heart issues three years ago I was whisked in through emerge, hooked up even before they completed the paperwork.
My total cost was just under $100 and that was for a private phone hook up and long distance calls home. The antithesis of this is waiting in emerge for 5+ hours to have stitches in a finger.
And being second last, giving up my position to a young mother with an infant who had been there longer... when the infant only had a cold but no family doctor was available.

I recently had a cat-scan for my back. I told them I would travel half the province... anytime, any day... that gave me about 6 options. Instead of waiting 2-6 months as usual I got in within 3 weeks...
actually two - someone cancelled last minute and that is another issue.

We can all give examples good or bad... the system has it faults. A lot can be fixed if there is a 'want' to fix it. I can give examples of over spending on supplies because it was always done that way
and people/systems don't change.

We have seen tourism killed here after 911 which equates to dollars spent here which equates to possible budget increases to Health Care. We have also seen government assist in killing tourism
with the removal of a link to the US, stoppage of HST reimbursements to the travelling USA citizens and unfounded increases in gas prices!

With the dollar on par we have lost a revenue stream of US citizens buying real estate here and hiring carpenters, tradespeople etc...

We have felt the economy dwindle...

It will be a long road to recovery if it ever happens...

The US needs to go back to an open border with Canada. Being in Maine, our family loved going on 1-2 day trips up into Canada- a wealth of beauty and culture. We used to drive to St. John for fencing tournaments -closer than Boston. Our last trip was to Yarmouth on the Cat, proceeding through Halifax to Cape Breton. All of that came to an end with the requirement for us to get a passport to be able to get back in to the US. (**** papers- create the climate of fear)
I curse homeland security and the government for infringing upon my freedom.

 

[WilliamBos]

The US needs to go back to an open border with Canada. Being in Maine, our family loved going on 1-2 day trips up into Canada- a wealth of beauty and culture. We used to drive to St. John for fencing tournaments -closer than Boston. Our last trip was to Yarmouth on the Cat, proceeding through Halifax to Cape Breton. All of that came to an end with the requirement for us to get a passport to be able to get back in to the US. (**** papers- create the climate of fear)
I curse homeland security and the government for infringing upon my freedom.

That is why I do not travel stateside anymore, the hassle given by the folks at Homeland security drives me nuts!

 

[Lloyd_E]

The US needs to go back to an open border with Canada. Being in Maine, our family loved going on 1-2 day trips up into Canada- a wealth of beauty and culture. We used to drive to St. John for fencing tournaments -closer than Boston. Our last trip was to Yarmouth on the Cat, proceeding through Halifax to Cape Breton. All of that came to an end with the requirement for us to get a passport to be able to get back in to the US. (**** papers- create the climate of fear)
I curse homeland security and the government for infringing upon my freedom.

tc...

Interestingly we have shared many things with our US neighbours over the last 300+ years. Sadly that has been diminished over time. We have friends/neighbours from the US that summer here. And they too complain about homeland security... and he is a Veteran. I guess we can no longer accept the simple things or simple truths in life or the simple bonds and respect for individuals. It is truly sad.

On another good note we have enjoyed the International Ox Pulls here between teams from Maine and Vermont and New Hampshire competing with our local teams. It is a highlight of my summer as I am interested in this historic event. I envy the height of the New England Ox build but I guess you need it to get through your 3-5' feet of snow every year... !

Lloyd

 

[CinderSchnauzer]

That is why I do not travel stateside anymore, the hassle given by the folks at Homeland security drives me nuts!

So far, touch wood, DW and I have experienced no particular problems going either way. Couple of times going acrosss with Son to pick up boats the US guys asked some questions that seemed a bit silly. "Why do you have such a big boat trailer?" UHHHH - so the boat we are buying will fit? "How many other boats do you have?"

But the real kicker came from Canada Border Services trying to come back home. They jerked him around for about 2 hours @ 1:00 in the morning and then when he asked (foolishly) what should be done to avoid the hassle another time, the answer to that took another hour. My sexist view of the thing - mid twenties female with a gun - middle of the night - chip on shoulder - power trip - nothing better to do - good entertainment.

I wouldn't mind seeing an open border either. Why is Free Trade only for the corporations? Why does a vehicle built in Oshawa Ontario sell for $10K more in ON than the same vehicle shipped to the US for sale? Because GM, Ford and all the rest of them can get away with it.

 

[Lloyd_E]

On Homeland security we haven't had any issues travelling into the States or coming home. On a recent trip(2 months ago) I drove an elderly neighbour to Bar Harbour to pick up a Boston Whaler.
He had all of the paper work in order in a brief case in folders. We explained on the way in that we would be back within 24 hours with a boat in tow.

We actually had more of an issue with the NB Highway Inspection - which actually turned out positive - we were polite, asked questions and engaged them... another story.

When we drove to Virginia several years ago upon entry we were questioned as to our purpose... told them who we would be visiting, exact address etc. It was early morning and the HS Officer apologized that he didn't know them... in a straight poker face. My wife got the joke I didn't!

I flew to FLA several years back with my wife, post 911... early morning departure from our little hole-in-the-wall international airport. We were first in line. Actually I was, attendant pulled me aside, said it was a random check. We had spent the last 10-15 minutes discussing our trip with her and life in general. I said random would be number 7 or 13 or 21 in line not number one! I was not amused...

Now on the way back home it was a different story... tanned, longish hair, bushy moustache, slightly hooked nose etc... you get the picture. I was pulled out of every line and searched. I was patient, said nothing, obeyed orders.

All good life stories I guess.

 

[brin]

On Homeland security we haven't had any issues travelling into the States or coming home. On a recent trip(2 months ago) I drove an elderly neighbour to Bar Harbour to pick up a Boston Whaler.
He had all of the paper work in order in a brief case in folders. We explained on the way in that we would be back within 24 hours with a boat in tow.

We actually had more of an issue with the NB Highway Inspection - which actually turned out positive - we were polite, asked questions and engaged them... another story.

When we drove to Virginia several years ago upon entry we were questioned as to our purpose... told them who we would be visiting, exact address etc. It was early morning and the HS Officer apologized that he didn't know them... in a straight poker face. My wife got the joke I didn't!

I flew to FLA several years back with my wife, post 911... early morning departure from our little hole-in-the-wall international airport. We were first in line. Actually I was, attendant pulled me aside, said it was a random check. We had spent the last 10-15 minutes discussing our trip with her and life in general. I said random would be number 7 or 13 or 21 in line not number one! I was not amused...

Now on the way back home it was a different story... tanned, longish hair, bushy moustache, slightly hooked noise etc... you get the picture. I was pulled out of every line and searched. I was patient, said nothing, obeyed orders.

All good life stories I guess.

You should be disgusted at what you are going through to get into the US....Just look at the border with Mexico...go down there and you can walk across...not a problem and if you get stopped, I heard on the news today,the border patrol has to accept whatever you say as true and let you go on your way... There is no telling who all is crossing the US border with Mexico unfettered and yet Canadians are harassed as we are if we try to travel anywhere...Go Figure ..

 

[chkntrktr]

You should be disgusted at what you are going through to get into the US....Just look at the border with Mexico...go down there and you can walk across...not a problem and if you get stopped, I heard on the news today,the border patrol has to accept whatever you say as true and let you go on your way... There is no telling who all is crossing the US border with Mexico unfettered and yet Canadians are harassed as we are if we try to travel anywhere...Go Figure ..

You beat me to it, but you said more than I would have and said it better.

Interesting thread about Canadian Health Care. I don't remember hearing anything but the very worst cases and the very best cases about ya'll during our debate down here, and of course that depended on which side was telling it. It's good to hear from people who live in the system and know the good and bad.

During the debate I always wondered where the Insurance companies and big health care companies stood on the issue. They were silent so far as I know. Don't know what it means but maybe some one else can chime in.