Crises do not just happen. Most times, someone causes the crisis.

A patient spends thirteen days in a hospital bathroom.

A man has his heart surgery cancelled four times.

A 15 year old hockey player, crippled in pain, waits ten months for hip surgery. 

An 18 year old dies after waiting months for a hospital bed. 

Someone cut hospital beds from 33, 400 down to 18, 500 between 1992 – 2017.  Ontario grew by 36% over the same period.

Someone keeps operating rooms closed, while patients in Strathroy wait an average of 671 days for knee replacement.  Someone makes patients wait, while the surgeons who replace knees go unemployed.

Of course, it is never someone. A mat of political webbing hides those responsible.

Players vs Being Played

Canadian Medicare copied the 1940s British National Health Service (NHS). After WWII, England wanted to extend its victory to social issues, so Aneurin Bevan, Labour Party leader, launched a campaign to create state medicine.

The British Medical Association resisted. It didn’t want bureaucrats controlling medicine.

Opposition threatened to ruin Bevan‘s plan. So he did what so many politicians do to get their way. He said, “I stuffed their mouths with gold.“

Note: This was not about negotiations of fees for services. It was about control, not funding. Bevan simply poured money into his plan making it irresistible to anyone who disagreed.  Continue reading “Medicare Provocateurs”

“I believe the term ‘self-regulation’ is well on its way to the dustbin of history.”

With this, the registrar of the College of Physicians and Surgeons of Ontario (CPSO) wrapped up his final note in From the Registrar’s Desk.

He went on,

“In the future, College work will no longer be described as ‘the privilege of self-regulation,’ but instead ‘the responsibility of medical regulation.’“

Candor comes easy when people leave office.

Is Self-Regulation Dead?

 

Was the registrar simply making an observation, or was he stating what he believes to be good? Does he believe self-regulation belongs in the dustbin?

I know many doctors who became Chiefs of departments. Chiefs oversee quality. They handle patient complaints.

Chiefs see problems before they become patterns. A good Chief tries to build safety into a department to prevent problems becoming patterns.

Good Chiefs try education, encouragement and incentives as ways to improve quality.

But they never eliminate problems, and many Chiefs start to despair.

So, they take charge.

They make tough decisions.

They put their faith in power: rules, oversight, punishment.

After 10 years in charge, some Chiefs are damaged; irreversibly anti-physician. They lose hope in clinical judgement and put their faith in systems instead of people. Continue reading “Is Self-Regulation Dead?”

We scrambled to book massages and orthotics for our children.

The year was almost over. We had unused health benefits.

Did they need a massage?

Who determines need versus want?

Do need and want overlap? If not, where does one end and the other start?

Economists teach us that demand for free products and services is infinite.

Voters experience the limits of free government products and services as rationing. Stuff runs out. Wait lines form. Continue reading “Moral Hazard and OHIP+”