Need to balance cost, quality in health care

During the past few weeks we have seen widespread news coverage of the poor state of care being provided to elderly people in nursing homes and other facilities. It is shocking to see the grossly inadequate staffing levels, staff training and facilities where our loved ones live out their final days.

What is not receiving the same media coverage is the truth that this low quality service is not unique to care facilities for the elderly. Many of the same problems occur in psychiatric facilities and general medical settings across Canada.

In recent years our government has been very focused on reducing costs. As such, it has systematically been replacing higher priced staff with lower priced staff. For example, a family doctor costs less than a specialist, a nurse costs less than a family doctor, an LPN costs less than a registered nurse, a care aide costs less than an LPN and the list goes on.

Of course it makes sense to hire people who cost the least while still having the skills and education required for a particular job. But this breaks down when those who are making the decisions focus solely on cost and not quality of care. What begins as a good way to trim excess easily becomes a blanket solution leading to serious shortfalls in skilled healthcare providers.

When a health region or hospital is given a budget and told to provide all necessary services with no deficits, planners are driven to do whatever is necessary to make it happen. Administrators who argue they can’t do it while giving sufficient quality, risk losing their jobs. Careers depend on the political will of the day.

I am not advocating the other extreme – funding everything with no regard for the bottom line. We have to balance quality and cost. In reality, our healthcare system cannot afford to give every person the best money can buy.

But I do think it is becoming increasingly obvious to the public as it has been to the medical profession for years that our government has focused too much on cost while neglecting quality.

Government deliberately reduced the number of doctors in order to reduce cost – reasoning that doctors provide services government has to pay for. Reduce the number of doctors, reduce the number of services and control costs. Unfortunately, this shortsightedness led to government closing training positions and failing to open new medical schools.

A predictable crisis was the result. Thousands of Canadians now cannot find a family doctor. New medical schools are opening, but it will take six to 10 years to produce any new doctors once the schools are operational – and most are not there yet.

In the meantime, people go untreated and end up with more serious medical problems and longer term disabilities – and the government doesn’t really save money in the end because the solutions will likely cost more than it would have to prevent a crisis in the first place.

By hiring the lowest cost employee without regard for quality, we risk dangerous situations. Without the education or skills to deal with complex issues, symptoms are often diagnosed incorrectly. This results in costly under-treatment or inappropriate treatment leading to prolonged disability for patients or future more expensive treatments that may have been prevented with better identification.

When working as part of a team it is easy to assume that all team members have a similar understanding pertaining to mutual practice or patient care. I have found this is often not the case. Training programs for different levels of healthcare professionals have very little in common. Many health care workers now have no scientific training or even fundamental understanding of what constitutes evidence of effective treatment.

Low cost facilities are another matter altogether. When psychiatrically disturbed, demented patients are placed in an ordinary, poorly staffed nursing home, it should come as no surprise when there are acts of aggression involving residents and staff.

During a recent media interview on this subject, a government minister said he had no intention of jailing the demented. My question is – do people really equate a properly equipped and staffed psychiatric facility with jail? This is the kind of facility needed for patients experiencing dementia.

These problems will only be solved through political action. To date, our government seems to feel the electorate will be sufficiently impressed with budget surpluses and will turn a blind eye to the abuses of the elderly, homeless and mentally ill.


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