Tuesday, September 6, 2022

A concern about the Canadian Health Care system

This is Joseph.

A 2017 CMAJ article has been making the rounds on Twitter that has the headline result of:
Medical assistance in dying could reduce annual health care spending across Canada by between $34.7 million and $138.8 million, exceeding the $1.5–$14.8 million in direct costs associated with its implementation. In sensitivity analyses, we noted that even if the potential savings are overestimated and costs underestimated, the implementation of medical assistance in dying will likely remain at least cost neutral.

While costs are never irrelevant and this was a pre-implementation estimate, there is a concern about focusing on costs in a context of medical resource shortages.  We also have concerning cases like the case where the only condition listed was "deafness" on an application for medical assistance in dying in 2019. Or the high profile concerns that Jennifer Gunter, a US physician, had for the end of life care for her father in Manitoba. 

Now, I know that people will blame COVID for the problems, and that is certainly not unrelated, but there consensus that this is also a problem with health care policy:

But experts say decades of bad policy, including the closure of hospitals and past austerity budgets, coupled with Canada's vast and complex geography, have exacerbated the pandemic pressure

And this is a real challenge to the goal of the system, to create equitable outcomes:

Canada's system, however, ranks lower overall than the UK and others in international comparisons . . . Canada specifically lags when it comes to equitable access and care outcomes.

Data over the last five years shows people are waiting longer in the ER before they are either seen by a doctor or admitted to hospital. Nearly five million Canadians don't have a family doctor, often making an emergency room their primary place to get help if they need it. 

 So I want to flag two important things. One, is there is a heightened need to be vigilant about processes like medically assisted dying in a context where care is hard to obtain. The risk of concerning events slipping thought is heightened when the entire hospital system is in crisis and people are overworked/burnt out. Two, that it is important to remember that the reason for a public-only health care system is to ensure equitable access and care outcomes -- making sure that more resources don't give better access to care but instead basing care on need. But that requires that these outcomes be equitable and that the level of care is acceptable (although perhaps minimally so) for all patients. 

If we can't do that then we need to think more carefully about what are the health care outcomes that we want. 

That said, everything I read suggests that there is a staffing crisis which is leading to issues like 20 hour waits in the emergency room. I hate to quote basic economics, but when there is a shortage of workers then maybe it is time to consider raising wages? Even temporarily? As a larger matter, it might not have been the wisest idea to let government funding drive the number of training spots, as it is possible for forecasts to be incorrect. 

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