"With regards to international comparison, the 2014 Commonwealth Fund report on the health system performance of 11 countries ranked Canada 10th overall, indicated particularly low scores in quality, safety, access, timeliness, efficiency and equity.17 "
17
Commonwealth Fund, Mirror, Mirror on the Wall: How the Performance of the US Health Care System Compares
Internationally, 2014 Update
So what are the administridiots proposing to remedy this awful situation?
The same old cheese!
Primary Health Care is the cornerstone.
Well, no kidding! The College of Family Physicians was promoting that since the 60s. In those days we used to say that would lead to better, more organized care that would be less expensive and that consultative services would be appropriately planned, avoiding unnecessary consultations and expenses. Further, we flattered ourselves by thinking that personal relationships and continuity of care were the patients primary considerations when, in fact, convenience was what was rated most highly.
The Ministry of Health janissaries are saying exactly the same things, offering nothing new other than their prolix memoranda.
It then goes on to answer the four aforementioned questions (discussed in a previous blog) with answers that only gives rise to further questions.
Electronic Medical Record adoption
There are currently more than 11,600 primary care providers enrolled in an EMR
adoption program, representing coverage for more than 10 million Ontarians. This is simply a statement of fact. There is as yet no evidence to indicate that the EMR, as it is currently set up has contributed to the quality of medical care. Nor has it contributed to the patient - doctor rapport. It has certainly contributed to the much lamented increase in cost of care.
The discussion goes on to bemoan the lack of funds and the growing geriatric population and the long wait times, inaccessible after hours services and difficulties for various groups to access various services. It mentions efforts in the past (similar, it would seem, to their present effort) that that failed to achieve the goals. The previous expert advisory committee produced over a hundred recommendations and by the their own admission this group found them not to have achieved noteworthy success. I have no doubt that these efforts cost a great deal despite their failure to address the problem satisfactorily. So far there is no reason to anticipate greater success with the present efforts. There is little doubt that it also will cost a great deal.
Here are their recommendations:
1. Groupings of Ontarians will be formed based on geography, akin to the assignment of students within the public school system. Citizens within each grouping are assigned to a primary care group (PCG) and then rostered to a primary care provider (physician or nurse practitioner) contracted by the PCG.
2. Each PCG will develop a system of coordinating the capacity of the delivery models in their region to ensure unattached patients are connected to a provider, thus ensuring universal access.
3. A system for managing exceptions will be developed. For example, patients with pre-existing relationships with providers who reside outside the PCG catchment area could be included in a neighbouring PCG allocation through PCG to PCG transfer payment agreements. Such a system could also be used to address commuters, seasonal vacationers, and patients accessing specialized primary care services (e.g., a falls prevention clinic, primary care of the elderly) in a neighboring PCG, or patients needing particular culturally sensitive care delivery.
4. Patients difficult to assign (e.g., those without permanent housing or without health cards) will be identified and assigned to the PCG in collaboration with Public Health, community health centres and the local municipal services. The funding formula would reflect the needs of this patient group; however, it is recognized that supplemental funding may be required.
I have little doubt that all these machinations will result in the generation of a whole additional cadre of well rewarded administrators.
Funny, seems like the system I left in NHS in Britain in 1963!!
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