AHS/healthcare system debacles

[kertejud2]

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Thats awesome - what is wrong with the politicians in AB? Why dont we have this same dual healthcare setup? Buy into private if you want.

Well simply put it's political suicide to frame it in such a way. But it seems most conservative politicians are just listening to lobbyists from the U.S. which isn't going to be good for anyone, and Liberal ones can't take the position that another country has a better system than our beloved one, so even if they did listen to people from other countries, they can't just openly support it.

Plus to make the actual incentives work, you have to break the costs down in such a way that it breaks the illusion that healthcare is 'free.' We know it isn't, but it feels free. I mean for some people I guess it can count as free, but that's a different issue. It's got that all-inclusive type of comfort about it that you're not afraid you are going to be paying anything more because you used the wrong thing. It's just a mental barrier, but it's a powerful one. You're replacing "free" healthcare with an itemized list of healthcare funding. It makes people feel uneasy.

Another reason is that most of these are effectively funded by turning the premiums into payroll taxes, which will naturally make employers livid. But this is also necessary to get the most out of incentives for private insurance (makes it important for employers to push private options as well). Now you could reduce income taxes in such a way that nobody is really paying anything more (this is easy to do for employees, hard for employers). You don't have to do the payroll tax idea and just pass it all to the individual's premium, but it does take away from the overall effectiveness of the funding model that incentivizes employers more. You're also actually adding costs where there weren't any before. Even with a re-reimbursement, the 'pay for access' parts that actually add efficiency and accountability to the system are a tough one to sell people on.

It also means more work for people. The nice thing about the 'all inclusive' feel of the system is that you can get by without doing a damn thing, really. Now you're telling me I need to look at providers, see if it's worthwhile to stay on the government plan or go with a private one? Accountants will like it, see a bit of an uptick in the first couple years as people try to navigate new deductions and incentives and the like.

This is also a system that would need to transition over a period of years. This is a $20B+ a year you're changing how it gets collected and allocated, that type of move doesn't happen quickly. Takes time to bring in the regulated private insurance side of things and get it running (they've got a foothold, but still takes time to implement the payment systems and navigate the legislation so they can actually come up with new plans and what not). This means that what will undoubtedly be the hottest political topic the province has ever seen, would probably span two election cycles, if not more, between announcing it and getting it up and running. The people pushing for it could be kicked out, the people replacing them trying to retroactively kill it or tweak it or whatever. You'd need a pretty determined politician willing to put their entire legacy on the line, and likely their mental health to boot. You're going up against something people generally love, up against the legacy of 'The Greatest Canadian' Tommy Douglas. Even if it does work out, it probably wouldn't be until years after you've been pushed out of public view because the system undoubtedly had transition struggles and was easy political ammunition for the years it took to find it's level and get people used to it.


It's not an easy sell, and you'd need somebody not beholden to private interests to get it done for the public benefit (who also is willing to admit the system can be improved by adding private services and funding). A politician like that would be tough to find.

[ZenOps]

As always, Canadian doctors can always apply for work in the USA. They could definitely make more money, and the USA definitely is in far worse shape than Canada in general health and in far greater need.

Thing is: In order to make money in the USA you will not actually be helping those who need the medical care, you will more than likely be doing things like transplanting organs from 18 year olds into octogenarians, or cosmetic dental procedures, etc. If you went to medical school to make money, then that could be right up your alley. If you went to medical school to improve health and extend life or some sort of idealistic notion, then you might be in for a shock as to what the US system has become.

Realistically, those teenage protestors in Hong Kong are all now organ donors. The USA is not all that different, nor is North Korea. Tonya Harding in the US medical system is something I would personally be strongly against, but it appears its already too late.



I'd suggest that if a nation were so bold. Simply do the exact opposite of what the USA is doing, and see if it becomes a healthcare utopia.

[TurboMedic]

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The most repeated reason I hear is that all the workers will leave the public system and go to the private.

Oh wait......You mean now the argument is that the private sector is more desirable than the public sector? I thought the public had it so easy and got paid best and all that jazz....oh yah that's just when it fits the narrative

[dirtsniffer]

Personally I don't think it's true, just going off memory why people say that the dual system won't work.

[benz_890]

9 hour wait time at Peter lougheed right now

[ExtraSlow]

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9 hour wait time at Peter lougheed right now

Top tip, you can check those wait times before you go. Much shorter elsewhere. Right now:


Might be worth driving south.

[killramos]

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Top tip, you can check those wait times before you go. Much shorter elsewhere. Right now:


Might be worth driving south.

Looks like priorities are in line lol

[ThePenIsMightier]

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Top tip, you can check those wait times before you go. Much shorter elsewhere. Right now:


Might be worth driving south.

There is a free app for this, as well.

[ExtraSlow]

Seems like more hassle than the website, but sure, whatever the kids want.

[ThePenIsMightier]

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Seems like more hassle than the website, but sure, whatever the kids want.

I always assumed their website was as mobile friendly as Netscape '99 but if it's ok, is prefer that over a silly app, as well!

[killramos]

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I always assumed their website was as mobile friendly as Netscape '99 but if it's ok, is prefer that over a silly app, as well!

They spend hideous amounts of time and money on it. Some parts aren’t half bad.

[ExtraSlow]

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I always assumed their website was as mobile friendly as Netscape '99 but if it's ok, is prefer that over a silly app, as well!

It works on my android device today without issues.

[suntan]

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Medicaid and Medicare covers the insurance for a small group of people (poor, elderly, disabled) but it still leaves them underinsured. And that’s the crux of the problem in the US, the high costs of drugs and health care, the high costs of proper health insurance, which leaves people vulnerable when real shit (ie cancer) goes down resulting in the mass number of bankruptcies. It’s better to bend the rules than to follow the system. You can’t beat the system unless you’re upper middle class or higher and can afford the premiums.

I doubt any politician can fix the pricing problem. Too many people are making too much money out of health care.

I'm not sure how one can go into the Mayo Clinic and get cured for cancer and then sneak out without paying.

Sure, it's underinsured. So is Canada's. And everybody else's. The same conversations happen everywhere. Japan's system has long wait times. UK's system has long wait times. Only certain things are covered.

Canada's problems aren't unique.

[davidI]

I was just reading this article and thought of this thread: https://www.latimes.com/science/stor...v0i0vhFaobOArw

In the United States, a legion of administrative healthcare workers and health insurance employees who play no direct role in providing patient care costs every American man, woman and child an average of $2,497 per year.

Across the border in Canada, where a single-payer system has been in place since 1962, the cost of administering healthcare is just $551 per person — less than a quarter as much.

The cost of administering this system amounts to 17% of Canada’s national expenditures on health.

In the United States, twice as much — 34% — goes to the salaries, marketing budgets and computers of healthcare administrators in hospitals, nursing homes and private practices. It goes to executive pay packages which, for five major healthcare insurers, reach close to $20 million or more a year. And it goes to the rising profits demanded by shareholders.

Administering the U.S. network of public and private healthcare programs costs $812 billion each year. And in 2018, 27.9 million Americans remained uninsured, mostly because they could not afford to enroll in the programs available to them.

“The U.S.-Canada disparity in administration is clearly large and growing,” the study authors wrote. “Discussions of health reform in the United States should consider whether $812 billion devoted annually to health administration is money well spent.”

[ExtraSlow]

I know when choosing a charity to support, I usually consider low administrative expenses to be a sign of good management. I guess the same should hold true for health care systems?

What's the administrative burden in other countries? Europe?

[kertejud2]

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I know when choosing a charity to support, I usually consider low administrative expenses to be a sign of good management. I guess the same should hold true for health care systems?

What's the administrative burden in other countries? Europe?

[rage2]

US is a completely different beast. This is nothing new, and comes from the complexities of medical coding and billing. I've worked with US health care companies before and there are more admin staff handling coding, billing, A/R and collections than health care workers.

[ExtraSlow]

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well, as usual Finland Finland Finland, the country where I want to be, pony trekking or camping, or just watching TV. Finland Finland Finland, it's the country for me.

But more seriously, it shows that while Canada isn't terrible by comparison, we could do much better without harming patient care. We could cut a third of our administrative costs, and have a lot more money for either more nurses, or other social programs. Aiming for a 2% administrative cost, isn't particularly radical, but would be huge in terms of benefits.

[dirtsniffer]

https://calgary.ctvnews.ca/mobile/ah...cuts-1.4795150

AHS review finds 1.9 billion annually in efficiencies.

The recommendations include expanding homecare, reconfiguring some rural hospitals and aligning beds with the needs of each community -- focus on getting patients the most appropriate care.

Workforce

Use evidence-based approaches to ensure optimal staffing levels and skill mix across AHS operations, including enabling staff to work to their full scope of practice
Work with unions to adjust collective agreement provisions to ensure sustainability
Review management positions based on peer organization benchmarks
Address physician compensation in AHS to align with other provinces, including reviewing radiologist contracts and use of stipends.
Clinical Services

Ensure patients receive care in the most appropriate settings by
Expanding community-based and home care programs
Aligning beds with patient need across the province, including acute care, long term care and designated supportive living beds with need across the province
Consider long-term care facility ownership and selling Capital Care and Carewest to independent providers, but only if there is an appropriate return and high quality care is maintained
Reconfigure small and medium community hospitals and emergency departments to better align with patient needs and provide better quality, without closing any facilities
Expand use of non-hospital surgical facilities
Expand clinical appropriateness initiatives to reduce unnecessary tests to improve patient safety, experience and access across Alberta
Maximize current outsourcing model across remaining laboratory services
Rationalize existing EMS dispatch and air ambulance bases toward the end of the existing ten year contract.
Non-Clinical Services

Reduce costs by outsourcing more nonclinical support services such as food services, housekeeping, protective services and remaining laundry
Explore revenue generation opportunities through expansion of preferred accommodation, retail opportunities, corporate advertising and space rental for underutilized space.
The government will not be following through on two recommendations outlined in the review as the health minister says there will be no hospital closures and there are no plans to consolidate urban trauma centres.

In the spring of 2019, Alberta spent just over $2 million to hire Ernst & Young to do the first comprehensive review of AHS since the health agency was formed in 2009. The review considered input from staff including about 1,200 physicians, 27,000 front-line workers and 4,200 AHS leaders, and from the public including about 1000 emails and feedback from 75 engagement sessions.

[rage2]

What does E&Y know about health care and efficiency? Fake news.