Wonderful and insightful article Dr. McGregor. It's unfortunate to see that research is not being used to make evidence-based decisions (i.e., all the research that shows that handling only the frequent flier won't alleviate the ER overcrowdedness problem).

In a business sense, it only makes sense to take the 'walking wounded' as its less costly to treat and easier to treat then someone coming in on an ambulance. This is too bad to see.

So I wonder why all this research is done, as business owners still get their way!

Business owners if they really cared about reforming the Health Care System, and assisting the ER crunch - should really try things like creating bed management software/modelling as that would really help all Canadians.

Excellent article in my opinion ...she says what I've said about our hospitals but so much more elequently. Hopefully, she will be listened to by the right people...but I won't hold my breath...

I'm sorry. I am reslly hsving trouble understsnding the concept of private health care in BC. Am I crazy or do I understand that public health care is funded by taxpayers money and private health care is funded by charging each patient from their own pocket?
Under the health care act in Canada is it legal for a provincial government to fund a private care clinic?
In my mind the big picture here is to show everybody that public care isn't working. And in doing so the government is funding private care to show us public care isn't working. What a croc.

And they had better be wearing GUCCIS,when they waltz in.

That way you can spot the peasants.

It is quite obvious that the reason they made the temporary deal with the BC govt. is that they're waiting for a Harper majority, plus the GATS and the NAU, all of which will have the power to dismantle the present medicare system, as "non competitive".

Look at Harper's record as the former head of the Citizens' Coalition, set up expressly to privatize and ruin medicare.

There already have been lawsuits by foreign investors in certain countries that allow two tier health care, against the publicly funded, claiming that it is "unfair competition" that cuts into their profits, therefore illegal under so called "free trade" and WTO rules.

The interesting part of big business' constant campaign for deregulation is that under phoney "free trade" treaties they have the opportunity to put the strictest regulations on democratic decision making powers by the people under the claim of "rules based investment regime"

Under the secretly signed TILMA traty between BC and Alberta, if Alberta goes two tier, as they have been threatening for years, BC will have to follow.

How many people have even heard of TILMA, yet our governments claim to be "democratic". The biggest BS .

People will have to understand once for all that privatization doesn't cut, but always increases costs to the public, which is then covered up by transferring the costs on other sectors, made possible through the monetary manipulation of costs.

The letters PPP stand for "Plundering the Public Purse", with endless precedents and examples all over the world, yet, bought and paid for governments still go for it, selling their own peoples.

Ed Deak. Big Lake.

The problem with not getting on line early enough is that folks Like Ed Deak gets to say thing that I would like to have said. Must get myself an alarm clock

a similar clinic was setting up in one of those socialist provinces. The guy got called in and told the truth about the Public medical system They allowed him to work as long as the bills go to the province and no extra charges for anything. But what really scares me is Gordo is back with another vision. BC will be rich by 2010. IF we are so loaded wish cash let's see some improvements in th old ER's. a few beds, a few operating rooms now used for storage closets reopened. The things I hear revolve around poor management of time and other resources. The private folks want to get dollars for the little things, high turn over. Hey we got that now, they are called walk in clinics, bing your care card not your credit cards.

Oh, ....I get it !!!

Doctors work on salary and are Public Servants ....and most others in the Public Health Care system are either candy-striper volunteers or willing to work for low wages/low benefits in the best interests of their fellow man.

Also, Public hospital's capital costs and operating costs are also free, via donated by some anonymous benefactor so that NONE of the rest of us have to pay a nickel .

What's the wait time in ER for an OX that was Gored? ...Is it faster service if your bring your own axe and grind it While -U -Wait ?

.....Same old sky -is -falling rhetoric ...

All medical costs come out of the tax base, because even privatized services, like dentists and chiropractors, are tax deductible expenses.

The same happens when a company sues the government for loss of profits. The court costs are tax deductible business expenses, and the defence expenses of the government also come out of the same public pocket.

This is something our "investors" never talk about, because it is a win-win situation for them and lose-lose for the public.

In any case, doctors are not on salary, they're contractors. And very well paid at that.

Ed Deak.

An informative article.

I would like to see more stats on on how BC's health care system compares to other jurisdictions in other areas such as in terms of Dr. to population ratio.

This doesn't really belong here, but it's the most current 'health care' thread available.

From today's Los Angeles Times:
http://www.latimes.com/news/opinion/la-oe-klein26dec26,0,5461327.story?coll=la-opinion-rightrail

WHy is it that the Campbell Liberals are trying to subvert Univeral Health Care at the very same moment that Americans are finally waking up to what a disaster the private system is down south?

And here's another interesting story about the wonders of American 'private' health care:

http://www.rabble.ca/news_full_story.shtml?sh_itm=c8483fda79d1ad02405981bb9fecaa7a&rXn=1&

Good -on -you Fiat Lux/ Ed...

At least you picked up on the Private -Public overlap with many of those parties directly involved in the PUBLIC Health Care System ,....and that it is often a seemless overlap. In other words, the Public Health Care System has had Private Contractors (ie such as Doctors )as a component since its inception.

What is also rarely , if ever, mentioned is that many health care costs are NOT free, or NO LONGER free , and are PAID for out -of- pocket whether one accesses (i) a Public Hospital/facility or (ii) a Private Clinic.

In an economic/political system built on fraud, lies, deceit and legalized crime it is not too difficult to find the contradictions.

This is what they call the "competitive equilibrium of the marketplace".

Ed Deak.

private health clinics? wouldn't want to give the citizens that can afford it free choice now, would we? why give canadians an incentive to make money and prosper? the gov't will take care of us all anyway, right lefties?

Ed, I'd heard about TILMA My God how can these two idiots/criminals get away with this? what's going on?
Some sites

http://www.canadians.org/DI/issues/TILMA.html

Nothing in media about gordo's taxpayer trip?
http://thetyee.ca/News/2006/03/06/GordonCampbellUK/
Hummm!
http://thetyee.ca/Views/2005/05/16/CampbellPickedEnemies/

Nice guys.
http://thetyee.ca/News/2005/04/25/TownDuped/

pRi--s
http://en.wikipedia.org/wiki/British_Columbia_Liberal_Party

The People of the BC/Canada United Will Never Be Defeated Its Time!

Back to sports elliot or someone will have to come down on you. 'We' doesn't include you dude - you're on your own.

The amount of claimed information evaluated for this study isn't likely accurate. Or am I just a cynic?

misinformed and a cynic nutter, that's all.

you're probably right. lefties don't care much for accuracy, unless it suits their needs specifically. it's easier to rouse the idiot masses with rhetoric.

Elliot doesn't really care for anything but vituperation and name-calling. He's much more comfortable behind the boards swearing at the referee and it shows. Nevertheless, lack of facts and insight never was a problem for sports fans or sports writers.

In the words of the immortal Forrest Gump, ‘Stupid is as stupid does.’

Hey sports dude, will the Canucks manage another win tonight?

The studies are accurate. the BCMA backgrounder is at http://www.bcma.org/public/news_publications/publications/policy_backgrounders/EmergencyDepartmentOvercrowding.asp
but the Ontario study isn’t free, so unless you have a subscription to Annals of Emergency Medicine (which I don’t) you can’t look it up. However, overcrowding is not strictly a Canadian problem - it is present in the US too as shown by this Mt. Sinai/New York State health department study at
http://download.journals.elsevierhealth.com/pdfs/journals/0196-0644/PIIS0196064402000586.pdf

Worse yet, here’s a study that shows how the marginal cost of an emergency patient increases drastically when the ER is crowded by more than double. It’s not what the study set out to find, but it is a significant implication. It also found significant economies of scale in large hospital ERs, mostly due to the large number of ancillary services concentrated in the same building.
http://www.annemergmed.com/article/PIIS0196064404013150/fulltext

When I was used to manage a small physical plant department in a local hospital in the 1990s, I got involved in developing low-level research for policy regarding building new hospitals, and the research showed the target number of beds appropriate for population was about 2.1 per 1000. Some regions such as Nova Scotia and PEI had up to 6.0 beds per thousand, and obviously had severe cuts to make (which they have still not completely done) while BC was not in bad shape, at 2.7 per 1000, less than Alberta at 3.2 per 1000.

However, as population increased in BC, the various governments (NDP and Fiberal both) failed to examine the impact and prepare adequately with new and compact facilities that were populations-targeted and more efficient to run.

Further, there is evidence (but no study I or the BCMA are aware of) that the 2.1 beds number needs to be increased, possibly to 2.5 or so, based on the increased survivability of patients at all levels, from trauma to geriatric multi-system medical failure. Doubtless someone is working on those figures somewhere, either here or in the States.

Godley’s facility, like it or not, is cherry–picking, and won’t make squat-all difference to ER waits as the above studies show. The problem is a shortage of beds. Private care is not the answer when profit has to be paid on top of costs, and when economies of scale cannot be captured because the facility is small.

I don’t blame nutter for wanting to know about the figures, but a little work digging will get him the results. Then we don’t have to do his thinking for him. Elliott, on the other hand, is truly an idiot. Break a leg, buddy.

And if you still think that private care is cheaper, think again. I can hardly wait for the presentation that the Denomination Health Association will make in the new year to the government.

The DHA is a group of religious-based health care providers that mostly provide intermediate/alternate-level/extended care (but some acute care too - St Pauls, St Josephs etc.) and assisted living for about half of BC's patients.

For a long time, the government has paid members of the DHA much less than private care providers for the same service - between $108-$146 per patient per day for those in alternate levels of care, while private providers such as Cambridge et al get $144-168 per patient per day for the same patients.

As well, DHA members are in the forefront of "aging in place" - where as patients get sicker, they can get transferred to other beds within the facility that offer more care for incrementally more money, rather than transferring them to a new facility, with all the upheaval that causes for patients, family and the hospital. It also preserves the patient's bed in the facility if they recover and are able to function again.

No private care providers are signing up for "aging in place". There's no money in it.

Last, DHA members has in many cases been able to preserve the jobs of union members by dint of good management of funds, while private care providers have been the first to contract out all services to reduce costs and inprove profits to their US shareholders. Incidentally, cleanliness and food standards have also fallen at these facilities, leading to a large number of complaints, more patient turnover and decreased bed utilization.

I recognize Cappy or nutter might not regard union jobs as a benefit to our society, but frankly, people paid $8 an hour to clean floors aren't out spending much money at the boxing day sales, so if either has a business, they should STFU and be grateful for the dollars. After all, the Retail Council of Canada is fond of saying that each dollar spent in the community is recycled throgh that community 8-10 times to the benefit of its members.

Huh. So much for the "efficiencies" of private health care.

nicely done Zalm - and Happy New Year to you and yours. Hope that injured wing has healed.

Thanks GWest. Unfortunately, even before I was able to get back to work, I tested our medical system yet again. On December 12th, just after getting my mother-in-law out of the hospital with her pacemaker, I slipped in the mud and broke my ankle and leg - classic Maisonneuve. Screws in the ankle and half cast for 6 weeks and physio when I get out.

Ouch!

Ended up testing VGH's service this time - not bad in most respects. Excellent physician knowledge, and the X-ray department has sprung big bucks for digital imaging that the hospital WAN can read anywhere in BC - more than $24 million on this alone the techs told me. Tremendous timesaver for physicians - the films were up on their screen in emerg before I got back to the ER!

However, like all hospitals, coordination is a big problem. I had no nurse.

Yeah, no nurse.

The doctor took me in from the waiting room, did a quick exam on my leg and got two ortho residents to look at me, all pending a history by the nurse...which was never done. By the time I was admitted to the surgical ward 8 hours later, only then did a nurse take my history, offer pain meds (too late!) check allergies, cut the clothing off, insert an IV etc.

There were nurses there, but nobody for me. Pretty shocking, so I e-mailed the nursing administrator and told her so. No reply yet...

Come to think of it, many of the ward nurses weren't up on their stuff either. Apart from the first one and the last one (6 nurses in 3 days), all the others until my discharge were new grads, and I had to tell them what to do with respect to doctor's orders, meals, physio and lab work. But you get that all over the place nowadays. As the older nurses retire, and middle-age nurses realize what a dead end nursing is becoming, all you have left are the idealistic new grads. And boy do they still need a lot of training.

I could fill a book with my experiences. But more apropros this article, could Godley's clinic have something for me? Yeah, taken a history, and then shipped me directly off to VGH. Nothing else.

Let's hope somebody puts two and two together someday. This won't go away if the US takes over our health care system. They have the same problems.

So sorry to hear you've stepped from the frying pan into the fire, so to speak. I hope it all sets up nicely and that 2007 has no more 'breaks' in it for you.

Interesting to read your reflections on the nursing situation. I'll post something in the other place about that in the next few days.

Cheers.

Fasinating stuff from some folks. I recently was advised I has a erratic pulse, tests done same day. Medication started that day as well. Cardiologist next day. Special heart x rays, visit surgeon in a week, Pace maker installation scheduled for 07:50 a couple of day later. I had nurses doing some tests, hooked me up and both surgeons saw me at 07:20. Done by 08:50. Good discussions on a couple of placs we had all lived. Sure takes the strain out of a procedure. There were two nurses as well as the three doctors. Only regret the guy was standing in front of the floriscope so I coudln't see them strigning the wires. Recovery room till 14:40. Home by 15:00. All tests , xrays included were on line.
If this is poor service, I wonder what some folks would consider good service. Oh almost forgot, it any symptoms appeared before the job was done, I was to go to the ER and get a pacer within a couple of hours. Didn't need to go there as everything was under control. My Care Card did the coverage. Private medical system, not for me.

My cousin approx two years ago went into VGH Emerg 15min wait, doctor checked his VS he was in OR in 2hrs for a pace maker!
He's still here!
Why is it always stated by media, government etc "a shortage of beds" when in reality it's "a shortage of Nurses"?
Very misleading propaganda.
If You go to most hospitals in BC there are many empty beds, why? Not enough Nurses!
We have a great public health care system!
Why wasn't Gordo's failed all expense taxpayer paid trip to Europe splashed all over the front pages of CanWest?
http://thetyee.ca/News/2006/03/06/GordonCampbellUK/

http://thetyee.ca/News/2006/03/08/UKCrisis/

Zalm, I don't mean to argue with you but some of your story doesn't jive with the realities of VGH procedures/ protocols; Yes I would know, you might have met me there. Still, I wish you a speedy recovery, and hope you have no need for hospital care in the coming new year. Health and happiness.

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http://www.iwtnews.com/pauljayreport
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I've been with them for 3 years now as they get ready to broadcast very soon, this is Exciting!

Late as usual, never mind. Have to get the steam off.

Any firm receiving a single dollar from the taxpayer should be compelled to maintain open books. False Creek Clinic dosen't, by prior agreement. Neither do we know if the cost of a suture in Godley's place is the same cost as a public suture. It could be twice as much.

Godley didn't borrow $10m to build his clinic without absolute assurance that it would be allowed to function. The no-you-won't, yes-you-will charade we all read about was just that - a theatre performance. Now he's operating under restrictions which will erode slowly but surely when no-one's noticing - by regulation instead of legislation, of course. Eventually he'll have a private hospital. The noise you hear is the HMO's over the line rubbing their hands together. Forget NAFTA, forget the Fed.

A few points brought out in discussions with other health care professionals,

1) Form a crown corporation generic drug company and supply 40-50% of the drugs used in the province at no profit.

2) Tell doctors they can opt in to the public system and work at government owned clinics for a salary or they can opt out and try to get patients to pay them directly (see point 4).

3) Run every available OR in the province 24/7 till there are no waiting lists - if we don't have enough staff to run them then get surgeons, nurses, technicians from Mexico, Cuba, India, Spain, Russia or anywhere else that has highly trained and highly motivated professionals (if we pay them what we pay our own most would be getting between 2 and 10 times as much money as they get at home) for short term contracts until the backlog is dealt with.

4) Allow doctors to form their own private clinics on 4 specific and exclusionary conditions;

1) patients must pay them directly (for which the government will reimburse the patient for the 'public cost')

2) these offices will pay a surcharge to the government equal to 25 times (or other ridiculous tax) the public cost for the procedure

3) doctors working in these clinics for even one day will not be eligible to bill the public system for any procedure for 10 years

4) any violation of these stipulations will result in public seizure of all clinic assets

sounds good to me jwlaurie
I thought this thread had died.

Hi blonde pit bull,

You're right - there was another story. Apparently, I had a chart there from two months before when I broke my wrist, so it was updated with this newer injury. The Emerg CO updated it intially after the questions he asked me. Long story, but I'm relatively satisfied that someone was looking after me, even though nobody but the MDs ever stuck their head in the door. There were apologies for the lack of pain relief but there was also discussion in that the ER CO knew that my wife accompanying me for the first 3 hours was also an ICU nurse at a different hospital and he expected that if there was a significant problem, that she would have brought it to their attention. I don't really think that was fair, but I also wasn't badly treated there, just in the dark, so as long as we all understand what happened there (and I think we do now) there's no need to say more.