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Q&A: What do Canadians really think of the state of health care?

Otto Akkerman, senior vice-president of health and pharma for Environics Research Group, takes your questions on a new poll which suggests Canadians are increasingly thinking money alone won't improve the health care system. Leave your questions here in advance, or join us live at 1 p.m. ET on Dec. 21.

  • Good afternoon, I'm Mason Wright and I'm an online editor with The Globe and Mail. We're joined today by Otto Akkerman of Environics Research Group, who worked on a study that found Canadians believe efficiency, not more money, is the top priority to address in finding solutions for our health care system. As you can see, several of you have chimed in already with your thoughts on what's ailing the system. Mr. Akkerman is here to answer your questions on the topic, and on what the results of the Environics survey indicate.
  • I am an RN presently working in the health care system. I can't see where more efficiencies will be made. I work on an acute surgical floor where many of the surgical patients have several chronic conditions, apart from their acute stage of needing surgery. Prevention has to be addressed, and people have to begin to take responsibility for their own health by vastly improving what they eat and how much exercise they get. One of the largest problems in our hospital overcapacity is the number of patients in beds that need to be in extended care. Staff cannot literally work any harder than they do. Perhaps we have to delist services such as knee and hip replacements, and to really look at the true benefits of chemo therapy (not much, apart from some childhood cancers).
  • All medical industry people take a 50% paycut and set about hiring more people ASAP!
  • I believe the pharmaceutical industry needs to be scrutinized. While the R&D is costly (although I believe, at least in Canada, our subsidized universities do much of the research, although I'm sure this is not the case in the U.S.). But effectively drug costs seem to be the driver for at least a portion of the increasing health costs. As well the federal government needs to help the provinces for long term care infrastructure as those who are taking up beds in hospital wards are plugging up the system all the way down to the ER's. As well perhaps a serious discussion is needed as to who actually receives universal health care. I know this is politically sensitive and perhaps I'm a bit naive but does a landed refugee / immigrant immediately qualify for the same benefits as a born citizen? I wouldn't want to deny anyone from getting treatment but has a study been done on this? As well the federal government along with the provinces needs to step up programs that ensure that Canadians have access to a family doctor. It seems to me that medical clinics don't have the long term relationship and something needs to be done (ie: educate the public?) on people arriving at the ER with problems that can be treated by the family doctor or medical clinic. As well communication standards need to be set to ensure that the entire medical community does not have a "silo" mentality. There needs to be cross communication to ensure that the system is efficient. Case in point. My Grandfather was admitted to the hospital and the family doctor wasn't aware until the family contacted her a week later. While the family should be proactive on this I was surprised that the hospital would not have a protocol to contact the family doctor immediately on admitting the patient.
  • Regarding landed immigrants, they have to wait for 3 months to be covered with phar, in macare; regarding medication cost in 2009 the cost of generic was down by 50% in all Canada and rebate was stopped for all medication. Privatization is not a solution, a more flexible system is required and more trained staff are needed comparing to other countries, Canada doesn't have any well trained nurses or paramedic as abroad. Bureaucracy is the problem. As a pharmacist simply by having more authority to prescrib antibiotics, proton pump inhibitors and some NSAIDs will ease the pressure on doctors more.
  • Do we pay enough taxes to cover all ailments of all people including aging seniors who need medical treatment to get a longer lifespan? Will 100% of our annual budget be sufficient to please all the people for all time.
  • I have worked in healthcare for 15 years and have seen a mushrooming of mandatory government initiatives - ECFAA, new privacy policies, procurement regulations to name a recent few - that require significant non-clinical resources to implement. Similarly, the cost of implementing technological efficiencies - ie: eRecords, Learning Management Systems - is expensive and eats up manpower. What is your view on how we allocate limited healthcare dollars in the face of these non-clinical demands?
  • Denise, I don't think the reference to effeciency is to how hard you work. I think it has to do more with the administrative side. Wasteful spending, cost over-runs, poor planning, that sort of thing. And of course I agree, prevention is also a huge thing. People let themselves get ill and then expect to be fixed. You smoke, you get cancer, you kinda did it to yourself, and everyone has to pay for it. I'm just advocating education to help change habits like that.
  • Death is a natural part of living. Don’t extend the dying process.
    Prepare for the eventualities that can be part of being an ‘old’ person.
    Not every cold or ache can be cured by a pill or some other form of medicine, everyone needs to understand this. And likewise, not every cold or ache needs to be xrayed, MRIed or investigated with every new fancy (or old) piece of gadgetry.
    Prevention: more emphasis on self care through diet and exercise.
    Don’t forget those with orphan diseases; these can be dreadfully devastating to patients and families.
    Communication: there isn’t enough time allowed to really listen and learn what a pt is saying. Skills of practitioners need to improve.
    Quit ‘spinning’ information: Cancer Care Ontario says that treatment is achieved within a suitable time frame. That doesn’t address the issue of the 6-9 months of travel through the system to get to the cancer treatment centre.
    Pharma: (new) meds are costing an incredible amount of money for an extended period of time.
    Allow all health care professionals to work to their fullest abilities. I find this is especially true for me in my position. And please hire the right person to do the job, i.e. clerical and cleaning staff.
    Electronic health records that are truly accessible in a timely manner and create communication between all the various labs, etc. that intersect to care for a pt. Also agree wholeheartedly that each individual should be able to access own records.
    There are a great deal of inefficiencies, some related to “how many people does it take to…”. Also, there are a lot of highly paid bureaucrats in hospitals.
    Sorry, I can’t take any pay loss. I haven’t had an increase in the past 2 years and it seems unlikely I’ll get any in the next few years but all of my living expenses have increased.
    Co-pays and paying for care: I think there is a place for both of these measures.
  • In the past - before someone had the bright idea of "capping" doctors earnings - I had no complaints with our health care system. Yes, doctors made a lot of money, BUT they also saw their patients when necessary (ie: when I was sick, not 2 wks. later) and did what was needed in one visit. Now I can only bring 2 problems/needs per appt. Got 3? Come back in 2 wks! Now, I have to have bloodwork every 3 months for a condition I've had for 20 yrs. that previously required it yearly. Oh yes - I also have to go to an appt every 3 months to get my prescription (that rarely changes) refilled. Total waste of my time and the doctors. I'm not sick, I don't need to be there! Most aggravating of all is having a doctor who listens to nothing you say - because she knows what I'm feeling better than I do! A day (at least) off work for tests I don't need can be expected at least once a year. A little better policing of the funding we have in place makes much better sense than pouring more money into an inefficient and inadequate system.
  • Seems to me your all barking up the wrong tree. First of all this is a big pharma poll. Who are the main force in telling government what health care plans we be. Get rid of them and all should work out, were people from cradle to grave will live a holistic life, look up Garrison institute. or see the move food matters. Its not rocket science folk, it plan and simple, but that don't make money. to bad so sad, and they will try and take away my organic heeling herb or make me a criminal when the pass some kind of legislation. Educated people, big money control's your health, you do not, lets take it back.
  • Otto Akkerman of Environics Research will be joining us here at globeandmail.com live, starting 1 p.m. ET on Dec. 21. Use the field below to leave a question for him about the poll that shows a majority of Canadians believe the key priority to fixing health care is efficiency, not more money (http://www.theglobeandmail.com/news/national/health-care-efficiency-seen-as-more-critical-than-funds-survey-finds/article2277911/).
    by Jennifer MacMillan edited by Mason Wright 12/21/2011 5:35:15 PM
  • I hope you can trust governments to make sure the health services you need or may need in the future will be there, and I believe you can. Health care has been a top priority for where Canadians want their government to focus since we began tracking the topic in 17 years ago. Governments can't ignore that fact.
  • My wife and I are approaching 65 and we have not abused the privileges of our health care system. We are in good health and hope to continue being so as long as possible. We now feel that our system is under threat especially for seniors. We feel there is a growing tendancy to underfund the system because of the increasing numbers of seniors who must rely more on the system. Should we trust our government to ensure that our worries are unfounded?
  • When will the government wake up to the fact that one of the major problems is the lack of family doctors? We had two in the area, now down to one, and he's close to retirement. What then, given that you can't get much of anything done without first consulting a GP?
  • Thanks for your patience, everyone. The next response is on its way... Keep submitting your questions and we'll get to them shortly.
  • Many Canadians, especially in non-urban areas, report encountering the same issue. Some regions are trying to respond by giving other healthcare professionals, like pharmacists and nurse practitioners, with authority that was traditionally with GPs. This may be an option.
  • @Otto Akkerman - Environics... "Governments can't ignore that fact." Given that governments ignored the growing, aging population when they decided to cap medical school admissions in Ontario and Québec twenty-plus years ago, I'd say they are very experienced in ignoring anything which doesn't suit their pre-conceived ideology.
  • How well does the desire for more efficiency rather than just more money tie in to ever-increasing drug costs and demands for expensive treatments for rare diseases/conditions to be government-funded?
  • I'd say they are strongly tied. Demand is increasing for higher-cost treatments and Canadians have made it clear they want to continue having them available. There is a growing sentiment that finding more efficiencies is the best way to accomodate this.
  • I'll post two comments before getting to the next question
  • Addressing the cost of medications alone will greatly help. Pharmaceutical companys don't need to be making billions in profit at the publics expense. They should be reined in on their pricing, and prescriptions should be prescribed only when absolutley necessary.
  • Nurses, and other healthcare workers are not overpaid as so many here are suggesting. A plumber and any other tradesman makes more an hour than I do and I have been a nurse for nearly 30 years. I hold a bachelors and master's degree. We need to trim bureaucracy and number of pieces of paper that have to be completed because all of those reports and documents take a battlion of people to manage them, and the patients need more people at the bedside caring for them. We need more family doctors, more urgent care centers that are open, more long term care facilities, and stop shoving more uneducated workers into the healthcare field to work because they are ''cheaper''. Look at the physical condition of many of our hospitals and be in horror. Especially in Northern Ontario. Where is the infrastructure money for buildings and maintenance when there is no ''millionaire'' in the community that wants to sponsor a new hospital wing? Where is the evidence that the gov't is working on the social determinants of health out there -- poverty, violence, hunger, crime. Reducing these plus improving health of the pop'n would impact our healthcare for sure.
  • There is a hope that Nurse Practitioners can do many of the tasks that a family doctor now does. is here evidence in favor of this notion from experience within or outside Canada?
  • Right now governments only pay for about 1/3 of all prescriptions in Canada with the remaining covered primarily by private insurance. This still represents a major expense. Many in the healthcare industry point out that generic drug prices in Canada are 70-80% higher than they are in other countries like the US.
  • Outside of Canada other healthcare professionals like pharmacists play a much larger role in primary care. Other countries have had success with this model.
  • I'll re-post a question from earlier today that hasn't been answered yet.
  • Bureauctacy and red tape seems to be the real reason for inefficiency problem with everything. Whether it be bureaucratic issues surrounding student loans, banks, insurance companies, or even children services, there seems to be a large amount of unaccountability within these systems. Is health care the same way? How much money is lost in health care bureaucracy and red tape? - money that only benefits bureaucrats.
  • I've done a lot of health research with nurses and I rarely see anyone in the system working harder. The admin task burden is often cited as an issue.
  • Health care policy experts have been trying to make the system more efficient for as long as I have been an MD (25 years). For every efficiency found, there seems to be at least two more expensive developments in care either new technology or new medications or new research that allows genomic correlation.
  • So my question is, why does anyone think that Canada's behemoth of a health care system can really be made more efficient? The nature of the beast is inefficient.
  • A big part of the issue that many of the people we speak with in healthcare cite is the fact that Canada is not one big system, but rather a collection of provincial systems that don't always work well together. Many people in hospital administration feel it's crazy that it's only been recently that hospitals in the same municipal area have banded together to pool purchasing to get discounts on everything from drug products to other supplies and doing this type of thing nationally would save considerable money.
  • Mr. Akkerman, you found that the majority of Canadians (52%) still hold a positive view of the health care system, the only G8 nation that can say that. What makes citizens of other countries pessimistic and what should Canada try to avoid in this respect?
  • For all its faults, Canadians, in general, still believe the system will always be there for them when they need it...citizens of several other countries don't have as strong a belief.
  • I'll post a few more comments from the backlog, followed by a question.
  • One of the biggest contributors to poor healthand thus, to our health care system, is a lousy diet, yet the Government does nothing to encourage healthy eating. Put a massive tax on junk food; frozen processed items that are filled with preservatives and so on. Buying a bag of chips should not be cheaper than a bag of apples. We have massives taxes on alcohol and cigarettes, but not junk food. Use some of the money to help grocery chains lower the price on healthy items such as dairy, fresh meats, grains and produce. For example, for every X pound of fresh food Loblaws sells they get X tax credit. The problem is that, the Food Manufactures and Pharma companies control the Government because of the billions they make and having a healthy society is not profitable.
  • @Jnap There is no evidence that nurse practitioners are less expensive. Nurse practitioner clinics in Ontario see relatively fewer patients than MD staffed clinics and the NP Clinics have overhead paid for them. NPs are not the solution to controlling costs. They may help to improve access but that's about it.
  • It seems that the government is too focused on funding as opposed to looking at how to fix the system. Besides this poll, what can be done to put this on the government's agenda and also make more Canadians speak up on this issue?
  • The perception of an over-focus on funding versus the fix is widely held by people in several countries, including Canada. Keeping the discussion at the forefront is important. However, while people are increasingly wanting to see inefficiency addressed, the appetite or openness to major structural changes is somewhat weaker and I think this is what has been acting as a barrier to change and action.
  • How will Canadians know when the maximum efficiency possible within Canada's health care system has been achieved?
  • While our guest is getting to this question, I'll just mention that we have time for probably one more question, but I'll post a few more comments in the meantime.
  • The answers have been around for ages. Focus on access to primary care and do it via appropriately trained persons. Nurse practitioners have been around since the 1970's but completely underutilized. McMaster's Family Practice unit pioneered their use and it is still going today. The reason they are not used is in large measure due to health politics, in particular physicians and how health professionals are paid. Governments budget medical services based on how much they pay physicians, there is no consideration of using non-physican practitioners like NP's and physiotherapists to do these services because they have to add more new money as the docs own the allotment for medical services. We need communitymedical clinics that provide a range of services instead of relying on GP's practicing in single offices (doc in a box) that are poorly linked with other practitioners. For years Health Care has been a service where companies expect to be paid higher amounts for services and productes rendered. E.g. How can a hosptial bed cost $12,000 and a car the same price? And don't even get me started on pharmaceutical costs and the over presciption of drugs in general but especially for the elderly. We can achieve significant improvments in quality of care at no additional costs - but the delivery structures need to change dramatically and we have to take a little better care of ourselves and live more healthy lifestyles as well - building more walking and excercise into our daily activities and eating less fast food and more healthy home cooked meals. This stuff is not rocket science. There are plenty of examples around the world, especially in the Scandanavian countries who tend to be leaders in innovations that actually work as opposed to some consultants fads.
  • Great question and the fact we don't have an answer is what many in health care management feel is the issue. Many point out that we don't have a consistent set of metrics and measures to evaluate efficiency and track how we are doing.
  • It seems that the process is expensive and clumsy. Example. Patient goes to GP with a small new lump on scalp. Gp looks at it and suggests dermatologist take a look . App't is made and specialist takes a look and thinks surgeon should remove . Pre op appointment is made, surgery is scheduled and performed in 10 min. Post op app't with surgeon is attended. Small lump removal means 4 app'ts and a brief surgery and lab biopsy. This seems clumsy and expensive.There must be a better way.
  • According to the Fraser Institute, I am paying around $10,000 a year in healthcare and yet I sit here with a crippled hand for which I have sought treatment for the last 5 years in order to resume my livelihood. There is a chance that if I had been able to apply those tax dollars to private medical care that my situation would be entirely reversed today. As it stands, I look forward to my next visit to the specialist who will once again shrug their shoulders at me and send me on my way.
  • When comparing our situation in Canada with our friends south of the line, we have to be thankful. But we cannot afford 2011 technologylevels for population as a whole.
  • RE: clumsy and expensive process - you give a great example. One patient going to 3 different types of physicians probably in different centres. Despite the fact that we have the technology, none of them have an efficient way to collaborate on this patient's health record. This is a common example cited by administrators.
  • Any parting thoughts, Mr. Akkerman? It seems there are a lot of clear ideas of the scope of the problem, but the solutions remain out of grasp.
  • What's happened to our stepped health care system in Ontario? There are supposed to be various types of clinics and hospitals to go to when we don't need a full-blown emerg. dept. But I don't know what these stepped clinics are...where they are...how to use them. I'm guessing nobody else does either. So we keep using expensive emerg. depts . What's wrong with those in charge? Is anybody in charge?
  • There are no shortage of solid ideas on how we can get more out of our system with what we have and I think that is why so many Canadians want the focus to be on the efficiency side of the equation. The big challenge is having people accept the changes that will be necessary. I look forward to discussing that topic at some point....thanks for having me.
  • That's all the time we have today. I'd like to thank Mr. Akkerman and the many readers who joined us to talk health care. Have a safe, happy and healthy holiday season!
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