Friday, July 15, 2005

Alberta Health Reform - "Action 4-12"

While it seemed like a good idea at first, there are 12 action points, and nobody wants to read me say "That's a good idea," 55 times ;-) . What I've done is reviewed all the remaining action steps and then I'll comment on the problem ones or potential problem ones (as I see it). Same assumption as before (I'm from Ontario, etc.).
[Action 5] Launch the Mental Health Innovation Fund
With $25 million a year for the next three years, regional health authorities will be able to expand access to mental health services and test new approaches such as telehealth, community extension teams, day and community support programs, and better linkages with hospitals.
If I can use my experience with Telehealth Ontario, I'd like to make a suggestion for a telehealth service in Alberta. Make sure that the nurses and/or health professionals that are on the line are up-to-date with the latest medical information. I remember calling them when I saw that a prescription medicine I was on was reported to have a side effect. Now, the side effect was not found to effect me, it was with children, but I was concerned. So, I called Telehealth Ontario and she told me to go see my doctor. I could have given myself that advice - I was looking for information on the drug side effects. Anyway, that's my advice for a Telehealth Alberta initiative.
Action 7: Expand Primary Health Care
[I]nstead of going to your family doctor, then being sent to a specialist, a dietician, a pharmacist, or a physiotherapist, how would you like to go to a clinic run by a team of people who put your health needs first? If it’s the family doctor you need, that’s the service you’ll get. But if a nurse practitioner or a pharmacist can answer your questions, that service would be there. And if you have a chronic illness like asthma or diabetes, a team of people would be there to provide support, advice and care. That’s what primary health care is about. And this kind of comprehensive, coordinated approach would be available to you 24 hours a day, seven days a week. Primary health care means better care for Albertans and, while there are some pilot projects in place, it’s time to expand the approach to more Albertans and more communities across the province.
We have this in Ontario now, and in fact, I just joined my family doctor's "Family Health Team". It included my family doctor, the other GPs, the specialists in the office, the 24 hour clinic downstairs, the lab down the hall and a pharmacy. Seems like a good idea - for the libertarians out there, keep in mind that when you sign up you give your doctor the authority to share your medical files with all of the other doctors within the team. If you're concerned by too many people seeing your medical history, you'll want to talk to your doctor. At least that's the case in the Ontario model, but I would imagine the same would apply in Alberta.

Now comes the meat of the debate:
[Action 8] Provide choices in paying for supplementary health services
Instead of having to pay directly, Albertans can use secondary insurance to help pay for podiatry and chiropractic services beyond what’s covered by Alberta health care.
This is the case here in Ontario, and it follows my belief and I think the general understanding that if the province does not cover certain health care, it can be paid for by the patient.
Provide choice in enhanced medical goods and services
People will be able to choose enhanced medical goods and services beyond what doctors decide is medically necessary – for example, a special kind of hip replacement. Regional health authorities will be able to charge reasonable fees for enhanced goods and services over and above basic services.
I think for me to buy into this, we have to define what is "beyond" medically necessary. I think this needs to be defined crystal clear because I don't want public health to be paying for bare minimums when better treatments are available. I would argue that:
  • If the procedure is not approved and is medically ethical (say, undergoing medical experimentation), then the patient can choose to pursue it at their own expense.
  • If the wait time to procure a procedure is too excessive, then the patient can pursue a private solution at their own expense.
  • The requiring government level to approve the treatment (new drug, procedure, etc.) will endeavour to make the new procedure fall under basic medical coverage as soon as it is proven to be the best solution. What I'm afraid here, is that if we have a bare procedure coming in, and then a better solution becomes available, the government will not approve it on the basis of cost. See this case in Ontario (Private clinic in Toronto to offer costly cancer drugs). The private clinic will provide drugs that Ontario will not (but Health Canada has approved). I'm afraid that while Ontario Health Minister George Smitherman indicates that it's got to be worked through the approval process - granted - but I hope there's no delay because of the cost.
  • The market will be free to provide supplementary insurance to provide for services not offered or approved by the government.
As if in response to my third bullet, maybe ...
A Healthcare Assurance Act could:
Put a strong emphasis on quality and require all aspects of the health system to meet certain standards and guidelines, protocols and best practices
This may address my third bullet point above.

All-in-all, I think this proposal is good. If I were an Albertan I'd be happy with this set of reforms with the caveats I've noted in this and previous posts.

1 comment:

Anonymous said...

Thank You! I was looking for something that helped me form an opinion on the proposal and the tid bits in the local papers didn't help me make any kind of informed opinion. you did a great job. Thanks from Alberta. Also reinforced my opinion that like in Alberta, there are also some really intelligent folks in Ontario