You can expect 4 features from almost all government services: paper, process, waits and privilege.
As every other industry moves away from hardcopy and convoluted processes towards convenience and transparency, Medicare pushes a wheelbarrow load of forms, complicated process maps, painful waits and privileged access.
Consider a recent trip to the Ministry of Transportation.
We stand in a line that stretches ten people in front and as many behind. People fight off numb feet by shifting from one locked knee to the other. Some stare at the ceiling, mouths half open. Like stuffing escaping an old couch, ownership papers and safety certificates stick out under folded arms.
A car dealer interrupts our REM cycles. He has a big smile, noisy shoes and forced laughter. He owns this office.
He leaves. We’re still in line. Another dealer swaggers in a bit later. The clerk giggles at his grin.
The staff seems busy. Each cubicle wall holds file folders intent on vomiting paper. Old-fashioned computer printers scream out perforated paper. Clerks tear, rip, stamp and sign. A paper jam requires two staff with special tools. It holds up all the other print jobs.
At the front of the line, a clerk asks why we’re there. Sorry. You’ll have to wait for a different agent. The next agent frowns when we show him our paper. Follow me. He ushers us down to a special counter at the back of the room, barely visible from the front, to wait behind a dealer.
Thirty seconds after speaking to the special desk, with four pieces of paper in hand – including receipt for payment – we toddle out thankful to feel the edema squish out of our feet.
Though the wait was painful, and the process impossibly convoluted, we leave impressed with the expert service provided by the person at the back of the room.
4 Features of Government Healthcare
Nationalized services have core similarities: paper, waits, process and privilege.
In healthcare, we still print, scan and fax things into and out of our electronic medical records. Whether it’s a consultant’s office, the emergency department or a local clinic, we put patients through multi-step processes for everything no matter how simple the problem.
Never assume you have a simple problem for a government service to fix.
Patients see their doctor in one place, go somewhere else for blood work, a third place for X-Rays and then wait weeks to discuss the results. But for those with connections, waits shorten and process becomes almost convenient. The forms, paper and charts usually cannot be avoided.
Does any other industry work like this? Airlines? Dentists? Auto mechanics?
Renovate vs. Demolish
In the movie Tomorrowland, the heroine asks, “What are we doing to fix it?” Despite the utopian promise, it presents a worthy challenge. Faced with bad news, we must choose to despair or resolve to fix it.
Medicare could use much less paper. It might become electronic as a way to serve patients, and not just as a means to control data.
Medicare could simplify processes. It would be hard to remove special interests that resist streamlining, but not impossible.
Waits could almost disappear. They create more work, not less. Doing work tomorrow that could be done today costs more, too. Canadians wait for many reasons, but mostly because we institutionalize waiting. It’s not necessary. And it’s not about money. Most incentives align to create waits. Other countries do not allow it.
Finally, we could offer all patients privileged access and service. Just like the Ministry of Transportation office lets the car dealers skip to the front of the line, Medicare could offer great service for everyone. But for now, there’s no reason to do it. In fact, being able to coordinate access and care for family and friends remains a special perk of working in healthcare for some people.
Can we envision a day when the 4 features of government healthcare disappear?
photo credit: teen.com
Giving an earlier appointment to a friend is illegal. You should realize that wait times were so bad in Ontario that in order to prevent favouritism, the government made queue jumping illegal. That is, it is more important to have equally bad than the best healthcare.
Great comment as usual, Gerry. Thanks!
Queue jumping of a discrete variable can be made illegal. I think everyone agree with that. If there is a list of operating room appointments, who you know should not determine your place on the list. (We can debate whether this still happens, if you want.)
Making a law against “queue jumping” for a continuous variable is nonsense. Clinical opinions do not rely on time-based aliquots to the same extent as operating room bookings. Friends can listen to your clinical opinion at a BBQ but they cannot get their cholecystectomy after-hours at social events. You can decide to pop into the office on a Saturday to help out your neighbour who’s heading off to Cuba that evening. You cannot pop into the hospital to operate on his strabismus.
I field requests and opinions from friends and family all the time, everywhere. I try to defer them to their own family doc as much as possible but many still want my ‘second opinion’. Many of my patients are also friends I see at hockey, church or school. They walk up to discuss their Januvia or any other concern. They’ve jumped the ‘queue’. Is that illegal?
Finally, hospital staff have direct access to medical opinions. Nurses tell emergency docs on duty when they feel chest tightness. They don’t ‘call in sick’ in the middle of their shift, walk to triage, wait, make a chart, then see the same emerg doc hours later. They ask, get an ECG and assessment, then make a chart if it turns out there might be more to their symptoms than a spicy lunch.
There’s so much more to say about this! Thanks for raising it.
Best regards,
Shawn
It’s better we all suffer to the same degree than for some to not.
Interesting thought. Many would agree with you. If you knew that some specialties increased their incomes between 2012 and 2014 despite most of the rest of us going down, would you change your position. What if you also knew that those specialties that increased were the highest paid to begin with?
The details reveal the devil on this one. Huge topic!
Thanks again for sharing.
Cheers
Shawn
Health Ministers have a problem in getting their plans implemented at the front line level. Governments can make rules but they can’t actually deliver health care services.
Well said, indeed!
Politicians hate that they have to work together with doctors to get anything done. So much easier to command and control if it weren’t for the terrible service and outcomes command economies create.
Thanks again!
Shawn
A few years ago a young asthmatic in Toronto died. The closest hospital emergency was on bypass as they were too busy to take any more urgent cases so the patient was taken to a different hospital.
Once the story hit the newspaper, the Health Minister gave an edict that hospital emergencies could no longer go on bypass. I asked an emergency doctor what he would do if all his critical care emergency equipment and rooms were filled and an ambulance brought another critical care patient in. His reply was: “I would flip a coin.”
I reiterate, politicians can give edicts and make rules but they cannot deliver health care.
Excellent example!