Waiting for Medicare’s Second Stage
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Slides from a talk at Ryerson University Health Service Management program's 1st Annual Symposium by Dr. Michael Rachlis. Reproduced here with permission
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Waiting for Medicare’s Second Stage
- 1. Waiting for Medicare’s Second Stage Michael M Rachlis MD MSc FRCPC Ryerson University April 25, 2009 www.michaelrachlis.com
- 3. Where are we now? Bay and Dundas
- 10. S Woolhandler Int J H Serv 2004;34:65-78 .
- 17. Swift Current Region Saskatchewan
- 20. What happened to the vision? 1962 SK Physicians’ Insurance – MDs strike
- 23. The Canadian system has long waits for care
- 24. Germany, CAN, US
- 25. Good News! We could solve almost all our problems with innovation and quality!
- 26. Good News! We could access primary health care within 24 hrs “ Even if we did nothing else, and we should implement other reforms, if every family physician implemented Advanced Access , every Canadian could have a family doctor.” Penticton British Columbia’s Dr. Jeff Harries to the CMA meeting, “ Taming the Queue”. Ottawa. March 31, 2006
- 29. Pooling referrals reduces waits
- 30. Waiting is just one sign of poor quality care
- 33. Do one-fifth of older Canadian women need to take Benzodiazepines? Do we care what we’re paying for?
- 34. [Green et al Soc Sci Med 2003; 57:553-60]
- 35. Disparities in health between different groups are responsible for 20% of health care costs Health Disparities Task Group of the Federal Provincial Territorial Advisory Committee on Population Health and Health Security. Health Disparities: Roles of the Health Sector. 2004 . http://www.phac-aspc.gc.ca/ph-sp/disparities/pdf06/disparities_discussion_paper_e.pdf
- 37. Catching Medicare’s second stage
- 38. “ I am concerned about Medicare – not its fundamental principles- but with the problems we knew would arise. Those of us who talked about Medicare back in the 1940’s, the 1950’s and the 1960’s kept reminding the public there were two phases to Medicare. The first was to remove the financial barrier between those who provide health care services and those who need them. We pointed out repeatedly that this phase was the easiest of the problems we would confront.” Tommy Douglas 1979
- 39. “ The phase number two would be the much more difficult one and that was to alter our delivery system to reduce costs and put and emphasis on preventative medicine…. Canadians can be proud of Medicare, but what we have to apply ourselves to now is that we have not yet grappled seriously with the second phase.” Tommy Douglas 1979
- 40. The Second Stage of Medicare meets the Quality Agenda “ Are we providing the safest, most suitable care? Are we investing enough in prevention? Are we reducing inequalities in health? The answer to these questions is no, not yet. But we could. It is the Council’s belief that we already have strong evidence and enough experience to pursue a quality agenda.” Health Council of Canada 2006
- 41. “ Many attribute the quality problems to a lack of money. Evidence and analysis have convincingly refuted this claim. In health care, good quality often costs considerably less than poor quality.” Fyke Report 2001 (Saskatchewan)
- 43. For profit patient care tends to be more expensive and of poorer quality – see PJ Devereaux et al -- but the most effective argument is: “Fuhgetaboutit!”
- 45. “ Courage my Friends, ‘Tis Not Too Late to Make a Better World!” TC Douglas (per Tennyson )