This is what we’re all expected to believe: if you cut the funding from hospitals and give it to community-based care, our health system will become more effective and sustainable.
The people who say hospitals should be nothing but acute care centers appear to be winning the debate on health care reform despite a lack of evidence to support their views. Those of us who suggest otherwise are quickly labelled dinosaurs.
Even the warm and friendly Canadian Centre of Policy Alternatives appears to be getting in on the act, suggesting in their federal alternative budget that as long as the community services remain not-for-profit, all will be well. They recommend an increasing share of federal transfers should be used to enhance primary and community-based care, not to support hospitals.
When we think about expensive hospitals, we think about beds.
And yet, the CCPA acknowledges that Canada already has the highest rate of day surgery in the world – an average of 87 per cent of all surgeries.
They point out that hospitals have only increased slightly as a percentage of spending relative to the size of the economy, from 3 per cent in the 1970s to 3.4 per cent in 2009. That’s more than 30 years.
The CCPA attacks for-profit surgical clinics, noting a Canadian study that found fees paid for expedited knee surgery in a private clinic cost $3,222 compared to $859 for the same procedure in a public hospital. Was the difference really all profit, or are economies of scale a contributing factor?
It wasn’t that long ago when we witnessed a discussion by members of a LHIN board who couldn’t understand how hospitals could deliver MRIs for much less than what was being charged by private clinics.
A few years ago when the Ottawa Hospital was asked to pitch in and rescue the Champlain CCAC from its management difficulties, staff told us the hospital was surprised to learn how much more the CCAC was paying for medical supplies. Apparently they were also astounded to find out that they simply could not go out and hire the wound care nurses they urgently needed due to the cumbersome contracting process at the CCAC. Hospitals can simply hire who they need.
We forget that many non-acute hospital services were developed in tandem with their communities.
For example, the Pinewood Centre, a mental health and addictions facility in the Durham community, was developed between the CAW and Lakeridge Health to answer a need in the community. It is efficient, effective, and accountable. Several years ago the government tried to get hospitals to divest unfunded mental health services. Pinewood was on the chopping block. The community rallied and eventually the province relented, providing dedicated sustaining funding. In a one-size fits all approach to acute hospital care, the Pinewood Centre would not exist.
About a month ago Kingston General Hospital announced it was beginning a leading edge postpartum health clinic at the hospital. Recognizing that pregnancy is effectively a stress test that can reveal underlying health issues, the clinic aims to follow-up with new mothers six months after giving birth to screen for heart disease risk factors and disease prevention strategies. This is smart preventative care. Problem is, all these politicians would rather not see hospitals do this.
Yet hospitals represent enormous hotbeds of medical talent and generate plenty of ideas for innovation.
Hospitals are also always there for us.
When other services fail, it is always the hospital that is asked to fill in the void.
The so-called ALC (alternate level of care) problem is often presented as an issue of hospital effectiveness. It’s not. It’s an issue of not enough services in the community. Yet we blame the hospitals for caring for people who have nowhere else to go.
When the Central East LHIN first signed accountability agreements with community-based agencies, the inconsistent reporting made it very difficult to assess the value of the work these agencies were doing.
A few years on we are now witnessing a considerable number of mergers as the LHIN tries to improve the effectiveness of these agencies.
This hardly sounds like an endorsement of the fairy tale idea that anything in the community is going to be both superior in outcome and more cost-effective.
The relationship between hospitals and the rest of the health system probably does need a rethink. But let’s not create a box that stifles creativity and automatically transfers services to an unproven alternative.
In fact, too often we discover that this transfer is non-existent. The rainbow of community-based care often turns out to be your spouse doing the best they can. MPP John O’Toole summed it up this way – the aging at home strategy is really the aging alone strategy.
Recently this DiaBLOGger made his way to one of the province’s urgent care centres to seek an x-ray of my left Achilles tendon. Under great pain from what turned out to be tendonitis, I hobbled into a crowded waiting room. When I got to the triage nurse I was told that they don’t offer x-ray services on the weekend. I asked where should I go? The answer: The hospital that was just around the corner from my house.
At the hospital I was triaged quickly, sent to an express desk, had my x-ray taken immediately. Within an hour I saw a doctor and was on my way home.
Had I stayed at the urgent care centre, I would have likely still been in the waiting room by the time I was discharged by the hospital.
We should be very careful of what we wish for. If I am a dinosaur, then hear me roar.