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Health Care Gets Harder When Politicians Make Medical Decisions

10/27/2015 05:17 EDT | Updated 10/27/2016 05:12 EDT
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View of a young male surgeon thinking in office setting

The current Ontario government is precipitating a health care crisis. What's worse is that the government has anesthetized the public by diverting all focus onto physician income.

Ask yourself: which story is more publicized -- so-called greedy physicians or a health care system choking on bureaucratic red tape? In this day and age of voyeuristic television, greedy doctors make for lively programming. Just like greedy unions, greedy teachers and greedy nurses.

And as the public watches "entitled" physicians struggle and crumble under the barrage of Liberal hostility, they miss the very real danger of a government stuffing an already glutted health care system with more administration. As David Gatzer pointed out, this is "a system designed for political popularity, not smart policy."

The Ontario Liberals have been in power since 2003. During a reign marked by fiscal scandal, they have convinced the public that a politician makes better medical decisions than their own doctors and nurses. Although our health care system needs a massive overhaul, this government has dragged its heels.

Until 2012 when they commissioned the Drummond Report, a 20-year plan that meticulously lists hundreds of cost-saving recommendations across various public sectors, including health care. One of Drummond's key recommendations: cut down on bureaucratic waste.

Given Premier Wynne's platform promising debt reduction, one would expect her to gleefully announce every penny saved through these recommendations. Instead, we get silence.

Since that first 543-page report wasn't detailed enough for the Wynne government, the Baker-Price report came along in 2014.

A light read at 34 pages, this report paints primary care reform in broad strokes, stating explicitly that its proposal needs further refinement. Yet, it is being implemented without further thought or contribution from vital stakeholders: front-line workers like physicians, nurses, or nurse practitioners; community agencies; local hospitals; or pre-existing government organizations like the Local Health Integration Networks (LHINs). In characteristically impulsive fashion, the Liberal government has decided this report is the blueprint to a better health care system.

According to this proposal, every Ontarian will get medical access. Increased accessibility and patient satisfaction will equate to better pay. It seems like such a simple solution to something as convoluted as our health care system.

But to paraphrase Mencken: "For every complex problem, there is a solution that is clear, simple and totally wrong."

It shouldn't surprise you that the Price report starts with adding another layer of bureaucracy to our congested health care system: the Patient Care Group (PCG). Another group of administrators to pay from a dwindling public purse. And like every dollar spent in taxes, there are two sides to this story.

Pro - Decentralize funding and administration of primary care.

Con - The creation of an entirely new administrative level under the existing LHINs will breed redundancy and extra cost. Money will be moved from direct patient care into the pockets of Board Directors.

Pro - All patients in a particular region are assigned to PCGs. All primary care providers -- nurse practitioners and physicians alike -- are contracted to the PCG. The PCG then pairs each patient with either a nurse practitioner or a physician.

Con - Your geographic location dictates who your provider will be. It does not matter if you do not get along with your provider, or if you specifically requested a physician, a nurse practitioner, or a provider of a particular gender. You have no choice but to accept a PCG's assignment.

Pro - All primary care is provided through the PCGs.

Con - Once this system is enforced, neither you nor your provider can opt out -- unless you move to a different province.

Pro - Payment for each provider is based on quality indicators such as: number of enrolled patients; number of patients booked for same-day/ next day visits; number of emergency department visits avoided; and how satisfied patients are with their access.

Con - By the time this system is rolled out across Ontario, many doctors will have left for fairer deals in neighbouring provinces. In the two weeks following the October 1 fee cuts, many family medicine clinics shut down; worse is yet to come. By the time the PCGs start, there will be fewer physicians in Ontario. At the same time, between babies, immigrants and refugees, the population of Ontario will grow at a relentless pace. More patients divided among fewer providers mean longer waits for appointments and fewer same-day appointments. Less accessibility means less pay for overloaded physicians and nurse practitioners who will then be unable to keep their practices afloat.

Con - If your doctor runs a family practice while doing obstetrics, anesthesia, emergency department work, inpatient care, nursing home care, or psychotherapy, access will be compromised. Even though such physicians and nurse practitioners are providing exemplary comprehensive care, their pay will be docked. Again, they will be unable to afford the cost of office rent, utilities, staff and equipment.

Con - When patient satisfaction is prioritized in medical care, a curious thing happens. Doctors, nurses and hospitals all provide poorer care. Patients get sicker. Patients die more often. And they do so while being very satisfied with care. Clinical assessments must remain unbiased; while patient feelings are important, they cannot drive medical decision-making. To do so means telling patients "it's okay to smoke" rather than helping them quit. To do so means sacrificing medical wisdom on the altar of popularity.

In 2006, primary care was revolutionized by the formation of Family Health Teams. Not even 10 years later, despite being wildly successful, these same FHTs are being insidiously replaced with PCGs. This is happening even though FHTs have been proven as recently as 2014 to score highly in terms of the primary care trifecta: accessibility, patient care and patient satisfaction.

So, why exactly are we abandoning a primary care model that clearly works and works well?

Perhaps it's high time we realize that health care is too essential to leave in the hands of short-sighted politicians motivated by election cycles and votes.

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