[LChoy]

Healthcare guy here

I skimmed most of the thread and wasn't sure if I should wade into the discussion.

- Private vs public: Our system (Canadian) is a lot more private than most people think. Almost all our healthcare is provided by private providers, it is just that it is paid for by the public purse (through taxes). However, the new trend, esp in BC and Que is a more private/private clinic style, where a patient pays a membership fee to a clinic in return for access to the healthcare providers of the clinic. It is a loop hole in the Canada Health Act, but still for now legal provided that the patient isn't paying for services covered, just for access. There are pros and cons to this, but I'll get into that another time
- The big push right now in Canada is to increase the efficiency in our care. The biggest drain on time and resources is Chronic Disease and continuing care. We just don't have enough space to house people with chronic conditions or in their late stages of life. With no place to go, these people stay in ER rooms and adds to the backlog.
- Increasing Access: There are many initiative being developed to help with this. There are 30-40% of the population in some places that don't have access to primary care services (family doctors). Mediclinics and walk ins help, as does PCNs (Primary Care Networks). We are also looking at how we can allow health professionals to practice to their full scope of practice. Nurse Practioners can actually do the job of most family physicians on a day to day basis (checkup, advice, medication refill, BP/Glucose testing..). We are giving Pharmacist increasing powers as well. This frees up more time more doctors to handle more serious matters as well as giving patients more 1 on 1 time with a health professional, not necessary the 3 min with their family doc
- I have to watch what I say since this is a public board, and I work for health, but a lot of the things I said above, are being fought against by "powerful forces"
- Primary Care/Prevention: Someone asked about primary care and prevention. There is a focus on getting people to stay healthy and avoid Chronic disease. The sad reality is that squeaky wheel gets the grease. our health budget in AB last year was $14B but most of the priority will always be with acute care, rather than preventitive care. However, there are incentives for physicians to add prevention and population health to their practice, even if it's just spending an extra min to advise their patients on reducing their cholesterol, BP, and other simple measures

- urban vs rural: It's hard to compare the States to us in Canada. Not only due to population, but the fact we have a lot of people that live in rural areas. City/urban hospital admission rates are in the 90% range if not always full. In rural hospitals, figures can be as low as 40-60% range. We're working to get more specialist to practice in rural environments, but most tend to operate in our cities forcing people to go to Edmonton or Calgary for major surguries.

- My own opinion. Both the US style and Canadian style have their strenght and weakness. As someone mentioned, it's unfortunate that the ideas around these two systems have become so entrenched. From the gov't perspective, esp in Alberta, we are much more pragmatic and willing to experiment with some aspects of the US system. For instance Health organizations such as Kaiser Permanante offer some excellent models on how to use multidisciplinary teams for patient care. We adapted that into our PCN models here. Same goes for programs such as physician and clinic incentives, Pay for performance, Medical assistance. For the States, they are learning about how we streamline administration, triaging, homecare, drug registration and approval

- That woman in that US commercial has irked a lot of people here in government, not only in Ontario. The official word is that if her tumour wasn't benign and her health was in dire shape, she would have gotten it removed right away, probably within the week. pre-op, surgery, drugs, and outpatient care (including future monitering) would all be covered by her insurance. In a private insurance model, it is this sudden emergency that forces a lot of people into financial trouble. However, because hers was more of an chronic rather than urgent, we're not as good with dealing with chronic conditions, so that part the States is probably a better model, provided she can pay for it. However, she would have gotten it removed eventually if she waited. The non-urgent nature of her surgery was the reason why her lawsuit was rejected.

- To be truely honest, if you were upper class to upper end of middle class with a great insurance plan, the States are probably better for you. They have access to up to date technology and drugs and you'll probably wait less and have more time with a team of health professionals.
- However, if you were middle to lower class, the Canadian system will look after you with or without insurance. You may have to wait, but the desperate and urgent will get seen


I'll try to keep up as much as I can on this thread, but if anyone has questions about the AB system, or the Canadian healthcare in general, PM or just quote me

PS. Spell check doesn't work on my browser, excuse my mistakes please