The upside of no-frills Canadian health care

Posted on January 30, 2014 in Health Delivery System – Comment
January 28, 2014.   Jonathan Kay

On Monday, beset by a minor (though not entirely inconsequential) medical agony, I took a cab to the emergency room of the Toronto East General Hospital, subjected myself to an unpleasant bit of surgery, and then traveled back home at 3am in a Percocet-induced stupor.

As with many Canadian writers, my primary thought throughout it all was: I bet I can get a column out of this.

“Columnist visits ER, opines on state of single-payer system: It’s a classic genre — of which our American friends will never know the joy,” shot back Chris Selley when I informed my opinion-page colleagues about my plan to write about Monday night’s abscess-removal adventure.

He’s right about U.S. pundits, of course. But perhaps that might have something to do with the fact that many Americans don’t realize how thoroughly they are being manipulated by emergency-room doctors.

Last week, the New York Times published a whistle-blower’s account of practices at Health Management Associates (HMA), a for-profit Florida-based hospital chain. “Every day the scorecards went up, where they could be seen by all of the hospital’s emergency room doctors,” the Times reports. “Physicians hitting the target to admit at least half of the patients over 65 years old who entered the emergency department were color-coded green. The names of doctors who were close were yellow. Failing physicians were red. The scorecards, according to one whistle-blower lawsuit, were just one of the many ways that [HMA] kept tabs on an internal strategy that regulators and others say was intended to increase admissions, regardless of whether a patient needed hospital care, and pressure the doctors who worked at the hospital.”

The case against HMA is part of a larger trend: “The practice of medicine is moving more rapidly than ever from decision-making by individual doctors toward control by corporate interests. ‘It’s not a doctor in there watching those statistics — it’s the finance people,’ said Janet Goldstein, a lawyer representing whistle-blowers in one of the suits.”

The goal in Canada is to heal the patient as quickly and effectively as possible, and get them out the door, prescription in hand, for home healing

Canadian emergency-room patients, by contrast, often have the opposite problem: Many could benefit from being admitted, but there are no beds available.

Almost all hospitals in this country are non-for-profit entities. They receive lump-sum “global budgets,” so every patient is a cost generator, not a revenue source. That’s why there are few of the retail-service bells and whistles of the kind you see in cushy American hospitals. The goal in Canada is to heal the patient as quickly and effectively as possible, and get them out the door, prescription in hand, for home healing.

My own experience in Toronto on Monday night was a case in point. After sitting in the waiting room for less than an hour (which isn’t bad by Canadian standards) in a stupor of pain, a doctor saw me, diagnosed my problem in less than a minute, froze the affected area, drew his scalpel, and then did unspeakable doctor things while I left my teeth marks on a rolled up towel. It was painful, brief, and performed with great expertise. And then, in a blaze of bloody gauze, my hero was gone. A minute later, before I’d even put my clothes back on, I heard him speaking with another patient.

I left Toronto East General without a single piece of paper — just a plastic wristband listing my allergies, and a hole in my back

Fair enough, I say: There were just two doctors on the ER floor that night — and this fellow couldn’t waste time on afterplay. Moreover, having read that New York Timesarticle a few days previous, I appreciated the fact that there was no bean-counting hospital official rushing into the room, trying to upsell me into a private suite for the night.

But once I began staggering to the exit, I realized that being on my feet wasn’t such a great idea. The pain was intense, and I felt feverish and dizzy. I turned around to return to the operating room from whence I’d come, but the bed already was occupied by a father holding a young child. So I simply rolled my body onto a random gurney in the hallway. No one thought this was unusual, as this sort of thing happens often in Canadian hospitals. A passing doctor even brought me some painkillers and a glass of water.

But eventually, it was expected that I get up and leave — which, after an hour, I did.

It was no-frills service. No customer-service agents. No admission scorecards. No how-did-we-do surveys. And no retail pharmacy either: Despite the money-making potential for such an in-house shop, the folks at Toronto East General instead sent me to the 24/7 Shoppers Drug Mart, half a mile away, for my meds.

Then again, on the plus side: no insurance-company paperwork, no panic-inducing after-the-fact letters about “pre-existing conditions,” no negotiating with hospital collection agents about who pays for what. I left Toronto East General without a single piece of paper — just a plastic wristband listing my allergies, and a hole in my back.

It was the Canadian health system, with its good and bad, in miniature. I wasn’t pampered. But I did get healed.

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