Canadian Centre for Policy Alternatives and the BC Health Coalition.
Press Release

(Ottawa) Surgical waitlists can be dramatically cut if governments develop a strategy to scale up innovations already underway in the public health care system, says a new study released today.

Why Wait? Public Solutions to Cure Surgical Waitlists looks at groundbreaking projects in BC, Alberta, Saskatchewan and Ontario that have significantly reduced wait times for procedures such as hip and knee replacements, cataract surgery and others.

The Saskatchewan Surgical Care Network, Canada’s first province-wide surgical patient registry, has used pro-active strategies to reduce wait times. “Accurate data is essential for creating management strategies and targeting resources for achieving long term success in wait list management,” says network Chair, Dr. Rob Weiler. The network doesn’t just report waitlists–regional health authorities are expected to actively manage them in partnership with surgeons.

The study also examines Alberta’s Hip and Knee Replacement Project and Ontario’s Wait Time Strategy, both successful initiatives. Five projects in British Columbia are profiled, including the Joint Replacement Access Clinic (JRAC) at Lions Gate Hospital in North Vancouver, where waits for the first surgical consult have dropped from almost a year to between two and four weeks. Without any additional resources, the project implemented common waitlits and a one-stop booking service that streamlines all aspects of patient screening and care before, during and after surgery.

The projects point to two key reforms needed in the surgical system:

* Team-based care in specialized clinics: Surgeons moved from working mainly on their own to working in teams in specialized clinics. The shift to team-based care means patients are better prepared for surgeries, operations are less likely to be cancelled, operating rooms function more efficiently and hospital stays are shorter. These projects also make greater use of nurses and other health care workers at every stage of the process.

* Pro-active waitlist management: Shifting responsibility for managing waitlists from individual surgeons to health authorities means patients can access the first available surgeon. Health authorities in turn can make sure efficiencies and best practices from individual hospitals are applied across the system.

“Canadians don’t need superficial wait time guarantees,” says study co-author Dr. Michael Rachlis. “We need a strategy that helps provinces implement the kinds of public sector innovations featured in this study. The federal government’s wait time guarantee fails to provide that leadership, and leaves the door open to private delivery.”

“Solving the waitlists problem will require some major cultural shifts in how our surgical system functions,” says co-author Marcy Cohen. “We need more collaboration, not a competitive private model that will siphon precious health care professionals out of the public system.”

“There’s this myth out there that only the private sector can innovate, but this study shows that is false,” says Rachlis.

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Why Wait? Public Solutions to Cure Surgical Waitlists was released today by the Canadian Centre for Policy Alternatives and the BC Health Coalition.

To arrange an interview, call Terra Poirier, 604-801-5121 x229 or Shannon Daub, 604-801-5121 x226 (cell 604-836-9372).

For BC Health Coalition interviews only, call Leslie Dickout at 604-681-7945.

* Editorial: Public Solutions Could be Undermined by Private Interests
* Press Release: Innovative surgical projects show how waitlists can be solved: Submission to BC ‘conversation on health’

Download the Report/Study:

* Why Wait? Public Solutions to Cure Surgical Waitlists – PDF File, 747 Kb
* SUMMARY: Why Wait? Public Solutions to Cure Surgical Waitlists – PDF File, 569 Kb

By Rose Ann DeMoro
South Florida Sun-Sentinel
August 12, 2007

News that some doctors in South Florida will now be charging patients annual “administrative fees” like credit card companies or banks is a sober reminder of how out of control our increasingly dysfunctional healthcare system has become, and in need of genuine, comprehensive reform.

On the same day the South Florida Sun-Sentinel reported the latest trend of doctors’ fees — on top of the other out-of-pocket charges for co-pays and deductibles — a Wall Street Journal/NBC News poll August 2 found that “costs of health care” is the top economic concern for Americans. Those findings echoed what has become a steady drumbeat this year. What is now evident is the problem is no longer just the 45 million Americans without health coverage, but increasingly the health insecurity for those already insured.

In January, a vice president of the Kaiser Family Foundation testified to the House Ways and Means Committee that one in six adults who are privately insured have “substantial problems paying their medical bills.”

In February, the journal /Health Affairs /projected out-of-pocket costs for consumers would jump 76 percent within the next decade.

In March, the journal of the American Academy of Pediatrics noted that families with high deductible health plans are far more likely to put off needed care due to the cost.

In April, Harvard researchers found that higher healthcare costs place a particularly harsh burden on women who typically have greater medical needs than men.

In July, a Rand study in the /Journal of the American Medical Association /reported that for each 10 percent hike in out-of-pocket costs, patients stop buying up to 6 percent of needed prescription drugs.

Some doctors may well feel squeezed by a health care industry where higher revenues and increased market share seem to be the new Hippocratic oath. But every additional tax and fee only exacerbates the crisis for patients and families.

And public anger is increasing at those who are profiting off their pain and health insecurity. The /Journal//NBC poll on Americans’ views on the economy also asked respondents to rate their confidence in 16 varied institutions. The bottom rung was firmly held by health insurance companies.

Those polled may not know the numbers, but they would probably not be surprised to learn that insurance industry profits jumped from $20.8 billion in 2002 to $57.5 billion in 2006. In the same period, drug company profits went from $64.4 billion to $94.8 billion, according to a June report by the Institute for Health and Socio-Economic Policy, the research arm of the California Nurses Association/National Nurses Organizing Committee.

Americans have had enough. Several recent polls have documented that two-thirds believe the government should guarantee healthcare for everyone, even if it means an increase in taxes.

There is one reform that accomplishes that goal — HR 676 in Congress, a single-payer system in the form of an expanded and enhanced Medicare for all. It would cover everyone with comprehensive benefits, choice of physician and hospitals, and end the thousand daily cuts of co-pays, deductibles, and new administrative fees. Perhaps best of all, it gets the insurance companies out of the way.

The public is ready. Now we just need our legislators and presidential candidates to follow.

Rose Ann DeMoro is executive director of the California Nurses Association/National Nurses Organizing Committee, www.calnurses.org.

Editorial
New York Times
Published: August 12, 2007

Many Americans are under the delusion that we have “the best health care system in the world,” as President Bush sees it, or provide the “best medical care in the world,” as Rudolph Giuliani declared last week. That may be true at many top medical centers. But the disturbing truth is that this country lags well behind other advanced nations in delivering timely and effective care.

Michael Moore struck a nerve in his new documentary, “Sicko,” when he extolled the virtues of the government-run health care systems in France, England, Canada and even Cuba while deploring the failures of the largely private insurance system in this country. There is no question that Mr. Moore overstated his case by making foreign systems look almost flawless. But there is a growing body of evidence that, by an array of pertinent yardsticks, the United States is a laggard not a leader in providing good medical care.

Seven years ago, the World Health Organization made the first major effort to rank the health systems of 191 nations. France and Italy took the top two spots; the United States was a dismal 37th. More recently, the highly regarded Commonwealth Fund has pioneered in comparing the United States with other advanced nations through surveys of patients and doctors and analysis of other data. Its latest report, issued in May, ranked the United States last or next-to-last compared with five other nations — Australia, Canada, Germany, New Zealand and the United Kingdom — on most measures of performance, including quality of care and access to it. Other comparative studies also put the United States in a relatively bad light.

Insurance coverage. All other major industrialized nations provide universal health coverage, and most of them have comprehensive benefit packages with no cost-sharing by the patients. The United States, to its shame, has some 45 million people without health insurance and many more millions who have poor coverage. Although the president has blithely said that these people can always get treatment in an emergency room, many studies have shown that people without insurance postpone treatment until a minor illness becomes worse, harming their own health and imposing greater costs.

Access. Citizens abroad often face long waits before they can get to see a specialist or undergo elective surgery. Americans typically get prompter attention, although Germany does better. The real barriers here are the costs facing low-income people without insurance or with skimpy coverage. But even Americans with above-average incomes find it more difficult than their counterparts abroad to get care on nights or weekends without going to an emergency room, and many report having to wait six days or more for an appointment with their own doctors.

Fairness. The United States ranks dead last on almost all measures of equity because we have the greatest disparity in the quality of care given to richer and poorer citizens. Americans with below-average incomes are much less likely than their counterparts in other industrialized nations to see a doctor when sick, to fill prescriptions or to get needed tests and follow-up care.

Healthy lives. We have known for years that America has a high infant mortality rate, so it is no surprise that we rank last among 23 nations by that yardstick. But the problem is much broader. We rank near the bottom in healthy life expectancy at age 60, and 15th among 19 countries in deaths from a wide range of illnesses that would not have been fatal if treated with timely and effective care. The good news is that we have done a better job than other industrialized nations in reducing smoking. The bad news is that our obesity epidemic is the worst in the world.

Quality. In a comparison with five other countries, the Commonwealth Fund ranked the United States first in providing the “right care” for a given condition as defined by standard clinical guidelines and gave it especially high marks for preventive care, like Pap smears and mammograms to detect early-stage cancers, and blood tests and cholesterol checks for hypertensive patients. But we scored poorly in coordinating the care of chronically ill patients, in protecting the safety of patients, and in meeting their needs and preferences, which drove our overall quality rating down to last place. American doctors and hospitals kill patients through surgical and medical mistakes more often than their counterparts in other industrialized nations.

Life and death. In a comparison of five countries, the United States had the best survival rate for breast cancer, second best for cervical cancer and childhood leukemia, worst for kidney transplants, and almost-worst for liver transplants and colorectal cancer. In an eight-country comparison, the United States ranked last in years of potential life lost to circulatory diseases, respiratory diseases and diabetes and had the second highest death rate from bronchitis, asthma and emphysema. Although several factors can affect these results, it seems likely that the quality of care delivered was a significant contributor.

Patient satisfaction. Despite the declarations of their political leaders, many Americans hold surprisingly negative views of their health care system. Polls in Europe and North America seven to nine years ago found that only 40 percent of Americans were satisfied with the nation’s health care system, placing us 14th out of 17 countries. In recent Commonwealth Fund surveys of five countries, American attitudes stand out as the most negative, with a third of the adults surveyed calling for rebuilding the entire system, compared with only 13 percent who feel that way in Britain and 14 percent in Canada.

That may be because Americans face higher out-of-pocket costs than citizens elsewhere, are less apt to have a long-term doctor, less able to see a doctor on the same day when sick, and less apt to get their questions answered or receive clear instructions from a doctor. On the other hand, Gallup polls in recent years have shown that three-quarters of the respondents in the United States, in Canada and in Britain rate their personal care as excellent or good, so it could be hard to motivate these people for the wholesale change sought by the disaffected.

Use of information technology. Shockingly, despite our vaunted prowess in computers, software and the Internet, much of our health care system is still operating in the dark ages of paper records and handwritten scrawls. American primary care doctors lag years behind doctors in other advanced nations in adopting electronic medical records or prescribing medications electronically. This makes it harder to coordinate care, spot errors and adhere to standard clinical guidelines.

Top-of-the-line care. Despite our poor showing in many international comparisons, it is doubtful that many Americans, faced with a life-threatening illness, would rather be treated elsewhere. We tend to think that our very best medical centers are the best in the world. But whether this is a realistic assessment or merely a cultural preference for the home team is difficult to say. Only when better measures of clinical excellence are developed will discerning medical shoppers know for sure who is the best of the best.

With health care emerging as a major issue in the presidential campaign and in Congress, it will be important to get beyond empty boasts that this country has “the best health care system in the world” and turn instead to fixing its very real defects. The main goal should be to reduce the huge number of uninsured, who are a major reason for our poor standing globally. But there is also plenty of room to improve our coordination of care, our use of computerized records, communications between doctors and patients, and dozens of other factors that impair the quality of care. The world’s most powerful economy should be able to provide a health care system that really is the best.

CBS
August 17, 2007

Right now, in the heat of August, we’ve decided to take the temperature of health care in America. It promises to be a big issue in the ’08 election, but often we don’t start learning about its intricacies until faced with serious health issues of our own. Then, the medical bills start piling up on the kitchen table, and you just don’t know where to begin.

Well, to get a handle on health care in this country, we fired off 10 Questions to two experts: On the right we had Robert Moffit, who’s the director of the Heritage Foundation’s Center for Health Policy Studies. We posted his answers last week.

(Public Citizen)

Now we have Dr. Sidney Wolfe, the director of Public Citizen’s Health Research Group. Public Citizen is a more liberal-leaning consumer advocacy organization. He’s testified before Congress numerous times — including just last month, on Oxycontin — and he edits WorstPills.org, a website that’s updated monthly and serves as a sort of second opinion on prescription drugs.

One thing we found interesting: when we asked the two men our first question — to name the one thing they’d change about the health care system — they both began with the exact same words: The financing. And then they diverged.

1. If you could change ONE thing about our health care system, what would that be?

The financing. Instead of hundreds of profit-seeking health insurers, money should be collected and bills paid by a single government payer.

At present, insurance company overhead and the paperwork that inflicts on doctors and hospitals wastes more than $350 billion a year — money that could cover the uninsured and eliminate co-payments and deductibles for those who currently have partial coverage. Progressive income taxes would be paid, just as we now do for other financially socialized benefits such as libraries, the police, schools, Social Security and, in the health area, for Medicare. Because of the huge administrative savings, a single payer system could cover everyone without expending any more dollars.

2. Most people agree that the costs are out of control. What can be done about that?

By far, the fastest growing element of cost is wasteful health administration. The number of doctors increased 2.5-fold from 1970 to 2005, largely in proportion to growth in the population. The number of registered nurses grew a bit more slowly. But the number of health administrators increased 26-fold during the same interval.

Another rapidly growing cost is the price of prescription drugs. Unlike all other developed countries where prescription drug prices are negotiated or controlled — and as we do for the Department of Defense and for the Veterans’ Administration — the costs for everyone else in this country are largely out of control and, for many, unaffordable.

The single payer approach could cut paperwork costs drastically, and force drug prices down.

3. What works in our system? What doesn’t?

Our system of medical education and our medical research are as good as most places in the world. But, because of the enormous expense of U.S. medical schools, much higher than most countries in the world, many students from poorer economic backgrounds are less likely to go into medicine.

The success of U.S. medical research would not be possible without the huge public subsidy through the NIH, now funded at more than $28 billion a year, another example of a progressively taxed, financially socialized benefit for everybody.

As discussed above, the current multiple payer financing is unaffordably wasteful and forces a larger and larger proportion of the $2 trillion we spend on health each year to fund people who are not, in any remote way, delivering medical care. They are not doctors, nurses, pharmacists or other health care providers but, in many cases, health care deniers whose job it is to fight with each other (insurance administrator vs. hospital administrator or doctor’s office administrator) to deny payments or even coverage for needed health services.

4. People come to this country from all over the world and get great medical care. But so many Americans slip through the cracks. What can be done to close this gap?

In what has been described as medical tourism, the United States, with its large pharmaceutical and medical-device industries and high-tech hospitals, has traditionally been a destination for patients, primarily those affluent enough to pay out-of-pocket, or those who have generous insurance coverage that extends beyond their countries of origin.

But recent years have also seen a flow in the opposite direction, with large numbers of American patients traveling abroad in search of less expensive and often more luxurious health care, frequently surgery.

The problem of Americans “slipping through the cracks” because of being uninsured or underinsured can only be dealt with by providing universal health coverage for all people in this country.

5. We hear a lot about the number of uninsured Americans. Just how many are there?

At the time of a government survey in 2006, about 43.6 million people in the United States, or 14.8 percent of the population, had no health insurance. But about 54.5 million people in the country, or 18.6 percent of the population, had no insurance for at least part of 2006.

An even larger problem is the growing number of people who are underinsured. Illness and medical bills cause about half of all bankruptcies, and three-quarters of these people forced into medical bankruptcy had health insurance coverage — at least when they first became ill. In many cases people cannot afford policies with optimal coverage, or they choose a policy with a relatively low premium but a massive deductible, often thousands of dollars a year. Such inadequate coverage keeps them from seeking care because of the unaffordable out-of-pocket expenses.

Conservative estimates are that about 100 million people in this country — one third of our population — are either uninsured or underinsured.

6. What’s the lowdown on managed care? HMOs? Single payer?

In its origins, managed care was dominated by excellent not-for-profit HMO models such as Group Health Cooperative of Puget Sound, located in Seattle. The market is now dominated by large, non-local, for-profit managed care companies, whose quality of care has been shown to be significantly worse than that of the non-profits.

Single payer means the government collects the money and pays the bills. By having all people in this country covered by a single payer health system, not just those on Medicare, our current expenditures for health — in excess of $2 trillion a year — could go much further and all but eliminate the serious problem of one out of three people being uninsured or underinsured.

In Canada, for instance, people can choose any doctor or hospital they wish to go to, unlike the increasingly restricted lists of doctors that managed care companies in this country allow.

7. What role should the government play in providing Americans with health care? What role should the marketplace play?

The government should guarantee that everyone in this country has health insurance by collecting the money and paying the bills, cutting out the pick-pockets in private industry.

The role of the marketplace — and this includes for-profit health service entities such as HMOs, hospitals, nursing homes and kidney dialysis centers — has been succinctly stated by my colleagues, Harvard professors and doctors Steffie Woolhandler and David Himmelstein. They co-founded Physicians for a National Health Program, which now includes more than 14,000 physicians, medical students and health professionals who support single payer health insurance.

In an article eight years ago in the New England Journal of Medicine, they wrote: “In our society, some aspects of life are off-limits to commerce. We prohibit the selling of children and the buying of wives, juries, and kidneys. Tainted blood is an inevitable consequence of paying blood donors; even sophisticated laboratory tests cannot supplant the gift-giving relationship as a safeguard of the purity of blood. Like blood, health care is too precious, intimate, and corruptible to entrust to the market.”

8. Is there a model for a health care system that you think works, that we might model our reformed system after?

The model we adopt for our single payer health care system can be crafted from the best elements of existing systems in the many countries, such as Canada and France, that already provide universal health care. All of these countries spend far less per capita than we do in this country, and everyone is covered.

The best models eliminate private health insurers, require that hospitals and other health institutions be run on a non-profit basis, and exercise strict control over the pharmaceutical industry. The multiplicity of state health insurance initiatives, with the exception of California state senator Sheila Kuehl’s bill, which advocates a single payer, are doomed to fail. They are thinly disguised versions of the failing system we have now, one dominated by wasteful private health insurers.

9. The baby boomers are now starting to retire, and people question whether Medicare will be able to handle them. Will it?

At present, Medicare is wasting about ten billion annually overpaying private Medicare HMOs, which have been touted by pro-market enthusiasts as the solution to Medicare’s problems. Doctors and hospitals drain tens of billions more for unnecessary, but profitable, procedures, drugs etc.

For instance, thousands of kidney dialysis patients have been given dangerous overdoses of epoiten because dialysis centers and drug companies have made huge profits from this drug. Similarly, about half of all cardiac stents are unnecessary, leaving the patient no better off, but gaining the hospital about $20,000 per patient. Eliminating HMOs from Medicare, reorienting Medicare payments to minimize incentives for over-treatment (as well as under-treatment), and encouraging primary and preventive care would go far to assuring the long-term viability of the program.

Assuring coverage for people under 65 would also save Medicare money. When the uninsured turn 65, their Medicare bills are far higher because they failed to get timely care.

Financing Medicare by a much more progressive tax, and improving Medicare coverage to eliminate current co-payments and gaps in coverage for prescription drugs would also broaden support for the program. Canada’s universal coverage program, which is also called Medicare, shows that national health insurance is the best solution to rising costs.

When Canada’s program began, in 1971, they spent the same proportion of GDP on health care that we did. Now they spend about 40% less.

10. What role will the health care issue play in the election? And is there a political candidate in this broad field who you think has the right idea?

We can not only hope that health care plays a major role in the coming presidential election but also that the ideas put forth are more progressive than those currently being espoused by all of the so-called leading candidates. Representative Dennis Kucinich is the only candidate with the guts and honesty to tell it like it is, instead of pretending that versions of our failed system can work. His support for the current single payer House Bill (HR 676) sets him apart from all the other candidates.

Dr. Laurence Jacobs
Rochester Democrat and Chronicle
Guest essayist

(August 14, 2007) — The movie Sicko has stimulated discussion of health care costs and access in the United States. Our patchwork nonsystem of competing health care insurances, with its profit motive driving denial of care and of physician choice, is clearly failing. It needs to be replaced by a more rational and humane method of assuring universal coverage and care for all our citizens.

Despite spending more per capita on health care than any other nation in the world, we lag behind in infant mortality and life expectancy rates. It is disgraceful that the richest nation on the planet is the only industrialized nation that fails to provide health care to all its citizens. We have 47 million uninsured, and more millions partially insured, or insured for only part of the time.

More than half of all personal bankruptcies are precipitated by the enormous cost of serious illness, despite the fact that more than two-thirds of these unfortunate individuals actually had health insurance prior to becoming ill.

Most Americans believe that health care should be available to all, but that is far from the case. Many uninsured people defer or neglect health care, including cost-effective preventive care, for fear of incurring debt beyond their ability to repay. As a result, early illness may become incurable; yearly an estimated 18,000 uninsured Americans die needlessly in this country.

The best way to fix this unacceptable situation is to shift to a single-payer health care system. Overhead in the private health insurance sector is estimated to be nearly 33 percent. Medicare overhead is less than 3 percent. The $350 billion in savings that would occur by eliminating the profit motive and moving to a single-payer system, like Medicare for all, would allow us to insure our entire population.

Why is overhead so high in the private sector? Just think of all the clerical and administrative staff necessary to run the incredibly complex system of deductibles, co-pays, denials and determination of who is eligible for what coverage and when. And then there is the issue of multimillion-dollar salaries for the executive echelon in the industry. Is this the way our health care dollars should be spent?

Many are concerned about government involvement in health care financing; one hears supporters of the present arrangements solemnly pronounce fear of “socialized” medicine. In a single-payer system, they predict, care will be rationed and the government will dictate who gets care and how. This fear-mongering is simply untrue.

Further, we already have rationing of care (based on ability to pay), and interference in the delivery of health care, by insurance companies that limit care based on criteria that they establish and interpret.

What I, and the other 15,000 members of Physicians for a National Health Program propose is a centralized system of payment, not a system for the provision of care.

Under a single-payer system, physician choice would be maintained, and decisions made in the traditional fashion, between physicians and patients. The driving force would be patient welfare, not profit. Such a system would dramatically reduce physician paperwork and frustration as well, and might help stem the rising tide of physicians leaving practice.

Politicians justifiably fear being attacked by the health insurance industry on the topic of a single-payer health system. But this topic is so important to so many of us that fear of industry reprisal or attack must be swept aside, and a rational plan developed to phase out our present inhumane and costly patchwork for a single-payer system. This is the best way to assure access to health care for all our citizenry and improve our population’s health. It is also the moral and right thing to do.

Jacobs is professor of medicine emeritus, University of Rochester, and vice chairman, Finger Lakes Chapter, Physicians for a National Health Program.