The worst-run industry in Canada: Health care
- 主题发起人 Buckwheattobe
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http://www.canada.com/news/national/Romanow+urges+narrow+focus+medicare+debate/3707545/story.html
Romanow urges narrow focus in medicare debate
OTTAWA — Roy Romanow says medicare has been "studied to death" and is urging Canadians to remember that the central question of a looming debate on the issue should be whether health care is a social good or an individual responsibility.
Romanow, who led a royal commission on health care nearly a decade ago, made the comments in an interview Thursday in the wake of a speech by former prime minister Brian Mulroney, who is calling for a review of whether medicare is financially sustainable.
Mulroney is proposing a task force of medical and financial experts to launch the national debate.
"There's nothing new here," said Romanow. "If this task force ever gets going, it's an exercise in rehashing issues that have been studied thoroughly. It's been studied to death by academics and others."
Romanow said he's not worried that some people, such as Mulroney, are talking about the need for a thorough review of medicare. This "pops up about every 10 years or so. You can't escape this debate, and you should welcome this debate."
But he added that it's critical to remember that if there is another review, it should revolve around a single, fundamental question.
"Essentially, this is a values-of-Canada debate. Namely, is health care a social good which is to be provided through the common wealth of governments — federal/provincial — in order to make sure everybody is covered? Or is it going to take on more and more the concept of not a common good but an individual responsibility? That means user fees and more privatization."
Mulroney, who led a Conservative government from 1984 to 1993, says Canada needs to strike a "better balance" between the "intrinsic value" of universal medicare and the capacity of Canadians to fund the system through their taxes.
His proposal for an independent review of the system comes as the Harper government and the provinces struggle with how to pay for rising health-care costs and with a 10-year federal-provincial funding formula set to expire in 2014.
Mulroney's remarks were made in a Montreal speech earlier this week to the Canadian Council of Chief Executives.
He told the business leaders their support for government initiatives on free trade, tax reform and deficit reduction was "indispensable to the discipline required from government."
"And we will need similar examples of courage and conviction to bolster our fiscal foundation against future pressures from an aging population and from increasing health costs impacted by the same demographic trend," Mulroney added.
"A serious, adult discussion is called for, and I believe a blue-ribbon panel of medical and financial experts could provide a sensible framework for the debate and for the decisions needed," he said.
Romanow, a former Saskatchewan premier, was appointed by then-prime minister Jean Chretien in 2001 to study medicare at a time when the system appeared to be in chaos. In the fall of 2002, Romanow delivered a report in which he concluded the system was financially sustainable if the federal government gave billions more to the provinces for health care on the condition they implement reforms in areas such as home care, primary care and pharmacare.
In 2004, the Liberals under Paul Martin struck a 10-year deal to give the provinces billions in extra cash, but Romanow said it came without the necessary strings attached for reform of the system that would improve its quality and make it more efficient.
As a result, said Romanow, while the system has been kept alive with extra cash, it hasn't been reformed for the long term. And so the debate is back.
Romanow urges narrow focus in medicare debate
OTTAWA — Roy Romanow says medicare has been "studied to death" and is urging Canadians to remember that the central question of a looming debate on the issue should be whether health care is a social good or an individual responsibility.
Romanow, who led a royal commission on health care nearly a decade ago, made the comments in an interview Thursday in the wake of a speech by former prime minister Brian Mulroney, who is calling for a review of whether medicare is financially sustainable.
Mulroney is proposing a task force of medical and financial experts to launch the national debate.
"There's nothing new here," said Romanow. "If this task force ever gets going, it's an exercise in rehashing issues that have been studied thoroughly. It's been studied to death by academics and others."
Romanow said he's not worried that some people, such as Mulroney, are talking about the need for a thorough review of medicare. This "pops up about every 10 years or so. You can't escape this debate, and you should welcome this debate."
But he added that it's critical to remember that if there is another review, it should revolve around a single, fundamental question.
"Essentially, this is a values-of-Canada debate. Namely, is health care a social good which is to be provided through the common wealth of governments — federal/provincial — in order to make sure everybody is covered? Or is it going to take on more and more the concept of not a common good but an individual responsibility? That means user fees and more privatization."
Mulroney, who led a Conservative government from 1984 to 1993, says Canada needs to strike a "better balance" between the "intrinsic value" of universal medicare and the capacity of Canadians to fund the system through their taxes.
His proposal for an independent review of the system comes as the Harper government and the provinces struggle with how to pay for rising health-care costs and with a 10-year federal-provincial funding formula set to expire in 2014.
Mulroney's remarks were made in a Montreal speech earlier this week to the Canadian Council of Chief Executives.
He told the business leaders their support for government initiatives on free trade, tax reform and deficit reduction was "indispensable to the discipline required from government."
"And we will need similar examples of courage and conviction to bolster our fiscal foundation against future pressures from an aging population and from increasing health costs impacted by the same demographic trend," Mulroney added.
"A serious, adult discussion is called for, and I believe a blue-ribbon panel of medical and financial experts could provide a sensible framework for the debate and for the decisions needed," he said.
Romanow, a former Saskatchewan premier, was appointed by then-prime minister Jean Chretien in 2001 to study medicare at a time when the system appeared to be in chaos. In the fall of 2002, Romanow delivered a report in which he concluded the system was financially sustainable if the federal government gave billions more to the provinces for health care on the condition they implement reforms in areas such as home care, primary care and pharmacare.
In 2004, the Liberals under Paul Martin struck a 10-year deal to give the provinces billions in extra cash, but Romanow said it came without the necessary strings attached for reform of the system that would improve its quality and make it more efficient.
As a result, said Romanow, while the system has been kept alive with extra cash, it hasn't been reformed for the long term. And so the debate is back.
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http://www.canada.com/health/Canadi...mprove+country+health+care/3355963/story.html
Canadian Medical Association report looks at ways to improve country's health-care system
REGINA — The nation's doctors are charting a new course to cure the country's sick health-care system.
The Canadian Medical Association has diagnosed Canada's medicare system as grim when it comes to meeting Canadians' health-care needs and being affordable for the public purse.
In its wide-ranging policy document entitled Health Care Transformation in Canada: Change that Works. Care that Lasts, which was released on Tuesday, the CMA states its three main goals are to improve the health of Canadians, to improve the patient's experience of health care and to improve the value for the money that is spent on health care.
One of many preions the association is writing to remedy the situation is the use of an incentive payment to reward a hospital, health region or physician for achieving quality patient care.
"In my mind, it's not about individual physician remuneration," said Dr. Anne Doig, president of the CMA. "Although having said that, I'll say there are indeed programs in existence in some of our provinces where there are incentives to physicians for doing things like chronic disease management. When we follow the protocols for ideal patient care, we are entitled to bill a little differently. We're also expected to spend a different amount of time with a patient."
She said there are quality markers — both in terms of outcome and process that can be identified.
"We can then use those as positive incentives for people to change their behaviour and the way they do things," Doig said. "That's the behaviour of physicians, that's the behaviour of other health-care providers, that's the behaviour of hospitals and that's the behaviour of patients."
The report cites a number of U.S. employers offer rewards to employees such as cash, merchandise, vacation days and reductions in health-care premiums or deductibles. In that jurisdiction, incentives are targetted at those who complete a health-risk assessment, quit smoking, lower their body mass index or remain tobacco-free for a year.
"If you really took the boundaries off the box, you could think of a system in which perhaps if we went back to having to pay for health premiums, maybe you would have people entitled to have a lower health premium if they met certain performance criteria in their own health behaviour," Doig said. "I'm not saying that we're asking for that, but I'm saying that is an example of what a patient incentive possibly could look like."
Canadian Medical Association report looks at ways to improve country's health-care system
REGINA — The nation's doctors are charting a new course to cure the country's sick health-care system.
The Canadian Medical Association has diagnosed Canada's medicare system as grim when it comes to meeting Canadians' health-care needs and being affordable for the public purse.
In its wide-ranging policy document entitled Health Care Transformation in Canada: Change that Works. Care that Lasts, which was released on Tuesday, the CMA states its three main goals are to improve the health of Canadians, to improve the patient's experience of health care and to improve the value for the money that is spent on health care.
One of many preions the association is writing to remedy the situation is the use of an incentive payment to reward a hospital, health region or physician for achieving quality patient care.
"In my mind, it's not about individual physician remuneration," said Dr. Anne Doig, president of the CMA. "Although having said that, I'll say there are indeed programs in existence in some of our provinces where there are incentives to physicians for doing things like chronic disease management. When we follow the protocols for ideal patient care, we are entitled to bill a little differently. We're also expected to spend a different amount of time with a patient."
She said there are quality markers — both in terms of outcome and process that can be identified.
"We can then use those as positive incentives for people to change their behaviour and the way they do things," Doig said. "That's the behaviour of physicians, that's the behaviour of other health-care providers, that's the behaviour of hospitals and that's the behaviour of patients."
The report cites a number of U.S. employers offer rewards to employees such as cash, merchandise, vacation days and reductions in health-care premiums or deductibles. In that jurisdiction, incentives are targetted at those who complete a health-risk assessment, quit smoking, lower their body mass index or remain tobacco-free for a year.
"If you really took the boundaries off the box, you could think of a system in which perhaps if we went back to having to pay for health premiums, maybe you would have people entitled to have a lower health premium if they met certain performance criteria in their own health behaviour," Doig said. "I'm not saying that we're asking for that, but I'm saying that is an example of what a patient incentive possibly could look like."
不合理abuse system的事情多着呢，你们上医院看看。相对有病排不上号的，有那种家里不让回家，long term care没床位，没有自理能力，只能在acute care不走的。还有30几的小伙子，据说一个能搞定好几个保安，吃着disability的救济，病因是constipation, 家里什么高档电器都有的混混（据说是黑社会的）。病人晚期，自己想palliative care。家人不允许，还要positive治疗，开刀，左一次，右一次，反反复复n多次最后还是死了。吸毒的毒品断档了，就弄个什么跑ER。反正这种人身上都是病。肯定是能住院的。然后在医院病人厨房偷医院的东西出去卖，掐着表要止疼的强力麻醉止疼药（等于毒品）。给治疗的药不吃，等住闷了，自己强制放弃治疗出院。反反复复老面孔每年医院能见好几次，冬天肯定能见。还有那种一看吸毒加黑社会的，纹身加10个大戒指的也是拿救济金的，出院前要见social worker提出，出院要政府福利提供一个轮椅。还要给安排福利的condo，townhouse房子住。跟他说了你这个矛盾呀，你要轮椅，condo，townhouse不是轮椅accessable的。噢，那么轮椅不要了，房子你们要帮助解决。
gocanoeing
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加拿大需要的是能负担的起（affordable）的医疗系统，不是免费（free）的医疗系统，有不少人把这两个概念混在了一起
现在医疗系统的主要问题我认为有两个。一个就是没有使用费（user fee），所以就有人abuse the system。另外一个是health card的信息并不准确，比如很多人没有在安省报税也可能拿到安省医疗卡，如果private insurance也这么管理，那早就破产了。
解决办法也很简单，那就是要付user fee，不过user fee应该和个人收入挂钩，比如总和不能超过个人上年收入的30%，超过部分政府全额负责。
另外，整个医疗保险系统也应该从public funded， public managed改成public funded， private managed以减少浪费，增加效率。政府员工的医疗保险就是（partially）public funded， private managed。
当然现在不改也没什么，反正总有一天会负担不起就会被逼着改。
现在医疗系统的主要问题我认为有两个。一个就是没有使用费（user fee），所以就有人abuse the system。另外一个是health card的信息并不准确，比如很多人没有在安省报税也可能拿到安省医疗卡，如果private insurance也这么管理，那早就破产了。
解决办法也很简单，那就是要付user fee，不过user fee应该和个人收入挂钩，比如总和不能超过个人上年收入的30%，超过部分政府全额负责。
另外，整个医疗保险系统也应该从public funded， public managed改成public funded， private managed以减少浪费，增加效率。政府员工的医疗保险就是（partially）public funded， private managed。
当然现在不改也没什么，反正总有一天会负担不起就会被逼着改。
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