A month ago, the NDP government in Saskatchewan announced another round of bed closures and service reductions in rural areas. In fact, this was a greatly scaled back version of what had been suggested. With the finance department still juggling budget figures as of May, the cuts proposed were dramatic. Fearing the political fallout, a smaller package of service cutbacks were decided on at, quite literally, the eleventh hour.
Rural hospitals are not well utilized - some serve as little more than expensive long term care for the elderly. Until, of course, a farm accident or heart attack occurs. My father, for example, went into the local hospital about 12 years ago for observation and suffered a heart attack while under a monitor and nursing care - and survived as a result of it. Forced to drive an hour that afternoon to seek medical advice when he wasn't feeling well, he may not have attempted - or completed - the trip.
That hospital was one of the ones reprieved in this last run of closures.
Closing beds in an urban center (in the city of Saskatoon, pop 200,000, there are three fully equipped hospitals) results in surgical delays and lengthened waiting lists. But 24 hour emergency and critical care services are not shut down.
Closing beds in rural communities forces rural families and ambulances to make increasingly lengthy trips to get treatment for critically ill or injured people - often over substandard, poorly maintained roads. The opportunity to stabilize a patient at a local facility is lost.
With the publicly funded hospital closed and private hospitals prohibited by law, large geographical areas are created where emergency medical care is effectively forbidden by the government.
In other words, zero-tier health care.
There may be a solution where these two problems - a shortage of advanced diagnostic services, and a shortage of rural emergency care - could be blended under a privately provided system. A government with imagination and courage could re-examine these small communities, and having satisfied themselves that hospital emergency services are not affordable under the fully funded public system, designate these areas as "free enterprise" health zones. In these zones only, investors would be allowed to set up private diagnostic facilities. Existing buildings would already be available for sale or lease.
There would be one provision - private servers would be required to provide basic 24 hour emergency services in the same facility. Residents who qualified to have their services covered under SaskHealth would still be covered in the usual manner, while those who wished to could purchase diagnostic services (or any other health service offered) privately or through different insurers.
The side benefit? Increased economic activity in smaller rural communities. Instead of farm families having to find expensive accomodations in the cities while awaiting diagnosis and treatment, urban residents would be travelling out of town to seek theirs - thereby, taking pressure off the existing MRI facilities in major centers while stimulating local rural economies.
Posted by Kate at June 9, 2004 7:41 PMTrackBack URL for this entry:
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Kate,
There are merits to your proposal, but there remain significant structural impediments.
Whereas investors may be licensed or allowed to set up these care facilities, what would they be, exactly?
Would they be required to staff these facilities with physicians, nurses, and other licensed staff already within the national health service? Similarly, who would underwrite their malpractice or other indemnity insurance, if they were essential not part of the national system?
In terms of purchasing, would the facilities be allowed to purchase medications and supplies under the national health contracts?
I suppose the quid pro quo for the facility investors would be that they would essentially be allowed the same privileges as the national health hospitals in terms of labor laws (if that's what they would want), purchasing, regulation, etc. for their putting up the capital and assuming the risk of their operation.
However, this seems to be asking a lot from both the investors and the government. What would prevent the owners from eventually demanding autonomy with regard to labor practice and administration?
If the current system was workable, the government-owned facilities would be in no need for financial support. You see, the problem is in the structure of delivering health care locally within a national-style system. It's the system that needs innovation, change, competition, etc. not just new ownership.
Posted by: MeTooThen at June 9, 2004 8:35 PMYou know, there are private health care providers and diagnostic services across Canada already.
"What would prevent the owners from eventually demanding autonomy with regard to labor practice and administration?"
You say that like it's a negative.
Let private providers provide, hire whom they want, under the terms they want to set. Just like private long term nursing homes, private MRI's, or abortion clinics do.
Those services that would be covered for Joe Farmer who has bleeding stopped in an emergency clinic in Climax, Saskatchewan would be paid for as surely as if he survived the trip to the nearest publicly funded facility. How the private provider spends the money and pays staff is up to him and the terms of their contracts - just as it is in any other private business.
Remember, I''m not talking about replacing existing facilities - just declaring an opportunity to be opened up in areas of the province that currently have no services at all.
Kate,
Perhaps I didn't make myself clear (OK, I didn't).
I am agreeing with you in principle, but my point (although poorly made) is that the current structure of nationalized health, I think, is too great a disincetive to privatize rural health centers. What I mean, is that I don't believe the government will ever allow it.
A government with imagination and courage...
This scenario is a slippery slope to ending a national health service.
Posted by: MeTooThen at June 9, 2004 10:31 PMOh, I know the government as it is would never allow it. Ideology, pure and simple, trumps all other considerations.
Posted by: Kate at June 9, 2004 10:59 PMHere in rural SW Ontario, a local Hospital (Listowel) has turned away people who come to emergency with burns and suspected fractures -- telling them to go to their family doctor. Never mind that the doctor could be a good 40 minute drive away! When this happens to your child, crying with pain and fear, it damn well makes you think about the promises of politicians, and the reality on the ground. Does this happen anywhere else, or is this the result of Canada's single payer, screw the customer, approach?
Posted by: Chris at June 10, 2004 12:16 PMFrance and UK appear to have no problem with a mixed health care system.
It puzzles me why Canada finds it necessary to emulate Cuba.
Posted by: Uncle Bill at June 10, 2004 7:32 PM