The alarming practice of decentralized administration
practiced by past governments has lead to a petite bourgeois of public health
care ‘servants’. They have gotten quite well-off planning health care
initiatives that never happen, or happen so poorly they need to be ‘managed’
all over again at great expense. We believe that a strong Health Care Ministry
manages the Health Care system for and around the health of the patients.
Successful Health Care is not measured by how much we spend (especially on
administrators), but by how well we spend to get the outcomes that we require
for our citizens.
Health care future policy is difficult because the various institutions are stuck with input management rather than outcome management. Without a patient based system contemplated under a previous policy initiative all constructive management becomes problematic. Nevertheless, until a patient based system is up and running, as health care costs are one of the largest and fastest rising expenses, we need to have some type of transitional phase. Two are being proposed.
ReplyDeleteAt bare minimum we need to produce comparative data from hospitals and other institutions in Manitoba versus hospitals and other institutions in other jurisdictions. Some line items which bear a little scrutiny could be :
patient day stays for various illnesses
capital cost per patient served
administration proportions
death versus discharge ratios
customer satisfaction
average emergency waiting time
supply and service cost per patient
For the time being the only really powerful tools of “management by institution” are probably the use of moral suasion to get people to accept that facilities have to at least reach the mid range of performance. As the data becomes better, health care users have a right to expect that administrators who are regularly unable to manage to some acceptable level of outcome will be replaced. This is a delicate transition in which patient care must be protected because bureaucracies always have a tendency to sacrifice others before themselves.
A second area of interest in the concept of promoting wellness has to do with the responsibility of individuals. We know that 90% of the health care costs come from 10% of the population. Improved wellness offers savings both through fewer people needing service and as well less service per person being required because the population is relatively more healthy. From a practical standpoint, we would need proper individual patient data to determine if individuals have been trying to keep themselves well. Hypothetically, if such data were available, a Provincial tax credit could be offered to better risk individuals just like MPIC insurance rates. Additional precedent also exists in terms of the Federal government offering a tax credit for youngsters engaging in healthy sports.
Unfortunately we do not have that data to work with so how could we make some kind of transition? How about a tax credit for a person who:
checks their own blood pressure weekly
charts their own progress
does not smoke
checks their cholesterol annually
participates in a regular exercise program
stays within healthy weight guidelines
visits a doctor once a year for chart analysis
The idea is novel. It is not for everyone. There could be implementation problems but putting something forward is certainly better than doing nothing.