In a recent blog I had written about the Barer-Stoddart report. This report was widely blamed for suggesting that medical school enrollment in Canada could be reduced by 10 per cent in the early 1990s. However, a more detailed look at the report reveals some interesting parallels to 2017.
Barer-Stoddart is not online, as it predates the internet. I read it, and what's really important to remember is that there were numerous recommendations, all of which had to be done in order. There first needed to be investments in team-based care, allied health professionals and much more, and ONLY if those investments were made could you then proceed to reduce the number of physicians.
Unfortunately, instead of implementing the report fully, Premier "I am Super Elite" Bob Rae's NDP government simply picked and chose which recommendations were politically expedient. They cut the number of physicians without ensuring supports for the general public were present and created the largest physician shortage in recent memory.
Fast forward to 2017. Health Minister "Unilateral Eric" Hoskins and his deputy health minister, Bob Bell, appear to be repeating the mistakes of the 1990s. Desperate to build a legacy in health care that will ameliorate their disastrous reign atop the health ministry, the two of them are pushing forward on the Patients First Act (PFA).
The PFA, however, is based on the Price-Baker report. This report studied population-based funding for primary care. In simple terms, this model proposes to create 84 regions in Ontario called "sub-LHINs." Each sub-LHIN will be given X dollars to cover all the primary care needs of the people in that region.
And you know what? This concept actually has merit! In the United States, there is a similar model called an Accountable Care Organization (ACO). It's been shown that when set up properly, with proper IT support and an administrative structure that breaks through the silos amongst the different, disparate group of health-care providers, ACOs provide higher quality care at lower costs.
Why then is the PFA doomed to fail?
Unilateral Eric and Deputy Bob have cherry picked the most politically expedient parts of the report and ignored the rest.
For the same reason Barer-Stoddart failed 25 years ago. Instead of implementing the Price-Baker report completely, Unilateral Eric and Deputy Bob have cherry picked the most politically expedient parts of the report and ignored the rest.
For example, one of the most essential features required to implement this is a strong health-care information technology infrastructure. This would allow different health-care providers to share relevant information about patients in order to optimize their care. In Ontario, the only place that comes close to having this kind of infrastructure is in the Georgian Bay region (where I was honoured to be the founding chair of the Family Health Team). My patients benefit significantly because of secure electronic communication between physicians, pharmacists, the hospital and several of the homes for the aged in the area.
However, this system doesn't exist anywhere else in the province, and it's an absolute prerequisite to implementing the changes proposed in Price-Baker.
Additionally, Unilateral Eric and Deputy Bob have chosen NOT to go ahead with the vertical integration of multiple services. This essentially means bringing multiple agencies under one roof to reduce administration costs. Kind of like a mergers and acquisitions do. (A certain boorish loudmouth had suggested this a while back). But the PFA really only gets rid of the CCACs (probably because they are the source of yet another Liberal scandal). Public health, municipal agencies and other social agencies that Price-Baker wanted vertically integrated are left alone, even though that's where the savings come from.
Also, Price-Baker stresses the importance of patient accountability. The expectation is that patients need to take some responsibility for their health care. Just because someone can go to the emergency department every day at no cost to them (but certainly to taxpayers), doesn't mean they should.
Patient accountability is clearly a touchy subject as my colleague Adam Stewart found out. He suggested patients should simply think before they access health care services. Adam did not suggest that people should pay for the services. But read some of the comments under his blog. "Absurd." "Shame on you." "It takes a lot of gall." And of course suggestions that this was somehow promoting two-tier care. But the reality is that some element of personal responsibility is absolutely necessary in the running of any health-care system. I can understand why Unilateral Eric and Deputy Bob ran from this, but it's still cowardly.
It seems the majority of front-line doctors remain disinterested in participating in planning for this.
What we have in the PFA is a cherry-picked version of Price-Baker. A version that increases the number of bureaucrats (84 more vice-presidents to be hired!), but does not provide the infrastructure to link health-care agencies or the vertical integration that is so badly needed to reduce inefficiencies in health care. The silos between most health-care organizations will still be there.
These are just some of the reasons that the Section of General and Family Practice (SGFP) executive has recommended to all family physicians that they NOT participate in planning activities for the PFA. This recommendation was recently re-affirmed but the executive. As currently constructed, the PFA will not put money where it's most needed — front-line care.
Now, it's true that a few doctors have gone against this recommendation (in what I feel is the naïve hope that they can minimize the damage from the PFA). However, it seems the majority of front-line doctors remain disinterested in participating in planning for this. In my area, a mere seven out of 72 possible doctors showed up for a preliminary planning meeting on this last year. Not really what you'd call good input. As an aside, you would think it would make sense for Unilateral Eric and Deputy Bob to reach out directly to the SGFP executive to see what could be done to increase participation, but...
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