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Jo-Ann Fellows

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Speak Up

Last week, I commented on the announcement made by Health Minister Mike Murphy on the next stage of health care reform. I want to continue my comments this week.

Three major issues were described: activity-based funding for hospitals, some possible private service involvement, and some new collaborative practice schemes.

The technical reforms in funding are going to require finding out what things actually cost in health care. Generally, if you can't cost something, then you can't manage it effectively.

Additionally, the minister insisted that he wants to "cut the fat" in the present system, avoid duplication, and tackle wait times in the province.

Concerning wait times, it is true that Canada has a poor record. A study by the Commonwealth Fund in April, 2006 shows that Canada significantly lags behind the United States, which lags behind Germany in wait times.

In Canada, nearly 30 per cent of people wait more than four months for elective surgery; 50 per cent of Canadians wait more than four weeks for an appointment with a specialist; 40 per cent wait more than two hours to receive treatment in an emergency room; and 35 per cent wait more than five days to gain admittance to a doctor's office or other primary health care organization.

It's a bit simplistic to put emphasis on wait times, since there are many situations where waiting is not significant in achieving good care, but we do need benchmarks to know how we are doing, and wait times are benchmarks.

I think specialization, another idea presented by the minister, offers good opportunities. We are a small province, and it costs us a lot to maintain health care for a sparse population that is largely rural.

I think it makes sense to centre a given specialty in one major hospital for the whole province. You gather the specialists together so they can support each other, they maintain their competencies from the number of cases that they treat, and skilled support staff is available.

We already do some of this in New Brunswick. For example, heart surgery and neurosurgery are available in Saint John.

Oncology is concentrated in Moncton and Saint John. You will have to travel to access these specialized services, but that is the trade off when it comes to good care.

Finally, there is one area I think requires discussion. Any changes must survive local politics. I think politics remains the elephant in the room.

Minister Murphy insists that he will not close a hospital, nor a single hospital bed, and here I think politics has trumped common sense.

I realize the major fights in this province have been over hospital closing, or hospitals being converted to community health centres. I understand why so much heat, if not light, occurs around this issue, but I think the opposition is wrong-headed.

There is agreement that a small, local hospital is inappropriate for tertiary or most secondary care, in comparison with the larger, better equipped hospital. If you are seriously ill or injured, you need to get to the large hospital.

Perhaps some other uses can be developed for the smaller hospitals. For example, there is a gap for some patients in short term rehabilitation coverage after discharge from hospital, and before they can return home. It might be possible to convert a small hospital into a rehabilitation centre. Likewise, seniors who are "parked" in acute care hospitals might be accommodated in a smaller hospital.

The system as a whole should be taken into account in dealing with the individual parts of it. Reforming our current system presents a significant challenge.

Jo-Ann Fellows is a writer with an interest in health care. She lives in Fredericton. Her column appears every Tuesday. Send comments to letters@dailygleaner.com.