How to better manage health system

Hospitals consume about half of the health care budgets in every province and only serve a relatively small percentage of the population.

Hospitals consume about half of the health care budgets in every province and only serve a relatively small percentage of the population.

It would, therefore, make much sense and could result in considerable savings if we take a hard look how these expensive institutions are managed.

Here are a few examples.

In essence, a hospital is like a hotel with a number of added services. Not by any means a five-star one, either. The older ones are often more like a two-star or lesser facility.

When you arrive, you park your car (for a price) and you enter an unimaginative lobby with, generally, uncomfortable chairs. If lucky, there will be a volunteer on duty directing you to take a number and wait your turn for the registration desk.

If there is no volunteer on duty and you have not discovered you need to take a number, you are in for a long wait. Even with taking a number upon arrival, you can still expect slow service.

You are assigned a room, which you may have to share with a total stranger, who may be hosting germs you do not want to go halves with.

I expect those conditions when I work in a remote settlement with limited accommodations for visitors, but here in the Lower Mainland?

The bed turns out to be high tech, but not quite as comfortable as the one at home. You kind of anticipated that.

For compensation, you have some buttons to play with, and these buttons make the bed do all kinds of amazing things. Not always what you had in mind, though, when your feet start heading for the ceiling and your head gets a lot more blood than wanted or needed.

Hotels of that caliber, minus the high tech beds, will charge you $30 or less a night. In contrast, the hospital stay costs the taxpayer anywhere from several hundred to many thousands of dollars a night.

Unlike any hotel manager, the administration has very little idea how and why this not so great and often not so clean facility is so expensive.

Simply put, there has been very little incentive for hospital administrators to find out. They get a certain amount of money every year, based on previous budgets and are expected to keep the place open. They do know where most of the money goes, but do not know if the taxpayer receives value for that money, and they do not really care since they are not required to think in a businesslike way .

In my mind, a hospital is a facility where patients receive care that cannot be provided elsewhere. The reality is, there are an unacceptable number of beds occupied for days or even weeks by patients just waiting for a procedure or tests. Part of that inappropriate utilization of expensive resources is caused by caring physicians wanting the best for their patients as soon as possible. It takes a lot of time and convincing the authorities that one is really sick and needs to be admitted ahead of the queue. Stretching the truth a bit will make the bed managers relent and allow an admission.

Once admitted, the patient gets priority for investigations or procedures. What otherwise would take weeks or months, is now accomplished in a matter of days.

Fair? That depends on your point of view. If the patient would have died waiting, and now gets his lifesaving treatment in short order, then this slightly underhanded approach is eminently fair.

Then there are the frail and elderly who cannot go home after they have been treated for the condition that prompted the admission. They have no place to go, since there is a wait list, sometimes a lengthy one. It is an unfortunate reality that there will be no room until someone else dies.

I wrote an article in the 1970s that Canada needed to provide 300,000 long-term care beds by the turn of the century to accommodate the predictable increase in seniors needing such care. Little was done and now the health care system is forced to spend vast amounts of money caring for folks in expensive acute care hospitals when these patients could receive better and cheaper care in well-managed long-term health facilities.

Talk about denial.


Dr. Marco Terwiel is a retired family physician who lives in Maple Ridge.

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