This is a piece I wrote for my political reporting class. Funnily enough, I originally thought about writing this story after reading an article in the Globe about the expert panel report on neurosurgery... and then the day after I submitted this story to my instructor, the Globe published another piece along the same lines.
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It’s been less than two months since the Ontario ministry of health and long-term care has implemented the first phase of an expert panel’s recommendations on how to improve access to neurosurgery. Already, the number of patients being transferred to the United States for surgery has decreased from at least 15 per month to three, a decrease of more than 80 per cent.
“We feel there’s an early success there,” said ministry spokesperson Andrew Morrison.
The expert panel report, which was released publicly on February 15, made 21 recommendations for ways to improve patient care. The first phase of action required the Ontario government to provide extra funding to the University Health Network, based in Toronto, so that 100 additional neurosurgery cases could be dealt with over the current and next fiscal years.
“From the ministry standpoint, we are not doctors and we’re not medical experts, but we are excellent at funding--we hold the purse strings,” Morrison said. “So what the expert panel told us was that if you’re able to fund additional neurosurgery cases, that should help with [reducing the number of] out-of-country transfers.”
Morrison said it will take time to determine how effectively the funding improves overall service to patients, but the short-term results look promising.
The funding will help obtain access to more beds, operating rooms and extra nursing and hospital staff.
However, in some cases it’s not just a question of funding but of qualified, available neurosurgeons. Morrison said there are shortages of doctors across Ontario and the ministry is working with training colleges and universities to expand medical education.
“That’s something that we look at (on) an ongoing basis, not necessarily related to neurosurgery but as an overall approach to healthcare in Ontario, and not just medical students but nursing students and all the other disciplines and allied healthcare professionals that are part of the Ontario healthcare system,” he said.
He pointed out that neurosurgery is a highly-skilled area of medicine, and that it may be difficult to find good candidates to fill those roles.
James Rutka, one of the authors of the expert panel report, said there’s no question that part of the problem is a need for more doctors.
“We not only need these trained individuals but we need more of them, because neurosurgery is a very exacting profession and discipline, and the population is growing but the number of neurosurgeons has not grown at the same rate,” said Rutka, a surgeon and researcher at the Hospital for Sick Children and the chair of the University of Toronto’s division of neurosurgery.
Rutka said part of the solution is to convince medical students that neurosurgery is a worthwhile specialty. Hospitals have to be able to promise students that after medical school and up to 10 additional years of rigorous training, there will be jobs waiting for them, he said.
The expert panel’s recommendations for phase two include “rolling out” the changes already put in place at UHN to all 13 hospitals in Ontario that provide access to neurosurgery. In order to increase access at all of these centres, Morrison said the government will be working with external healthcare providers. This means Ontario citizens will get the benefit of publicly-funded healthcare while also using the services of private healthcare teams.
So where is the line between public and private healthcare?
Morrison emphasized that “the government is committed to offering universal, publicly-funded healthcare to Ontarians,” and that any services funded by the government are public services. He also referred to the Commitment to the Future of Medicare Act, passed in 2004, which closed the loopholes to extra billing user fees and privately-funded healthcare that were discovered in the past.
Essentially, contracting out to external businesses to take care of shortages in neurosurgery was part of the problem, not the solution, said Morrison. “That’s kind of what we were doing—we were sending emergency cases out of the country. So we were paying an external provider to do the work.”
Instead, the ministry is focusing on keeping neurosurgical procedures inside the province—even if it has to put up additional funding and bring in outside specialists to do the work.
Ontario isn’t the only jurisdiction in Canada to be making changes in the direction of two-tier health care. The Globe and Mail reported in a recent article that Quebec health minister Philippe Couillard has agreed to allow doctors to have “duo” practices in both the public and private systems. The change came as a response to a provincial healthcare report called “Getting our money’s worth” which proposed many changes, including allowing private insurance companies to cover public health services.
Couillard cautioned Quebecers about the changes, saying they “must have no impact on the public health care system and no impact on access to care by the general public.” But critics, including University of Toronto law professor Colleen Flood, have said Quebec has taken a firm step toward a two-tier system.
Rutka said incorporating the private sector into neurosurgery wouldn’t work, though it might for other areas of medicine.
“You couldn’t set up a private clinic with a building that would have everything that a neurosurgeon needs to do neurosurgery without investing millions and millions of dollars, and for a relatively small number of patients who would benefit in a private clinic setting from that kind of service,” he said.
“It just would not make any good business sense.”
Rutka said that for other specialties that are less cost-intensive than neurosurgery, it may not be a bad idea to look into privatization. But he also believes in improving the system we already have.
“I’m a firm believer and very proud of the Canadian healthcare system,” he said.
“On balance, it’s a wonderful system that we have in place here. It can be better, and we slipped behind on losing patients to the United States with these transfers because our system became full. But it’s a correctable problem.”
The expert panel will be meeting again within a week.
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