Wednesday, May 16, 2007

Thinking outside the box in health care

Despite how it sounds, the idea of renting unusable hospital space - particularly ORs - on off hours was a good way to think outside of the box and recoup some health care monies.

Similarly, I applaud the announcement that the province will follow the lead of many other jurisdictions in this country and allow midwives to work in our hospitals.

Midwives can do nothing but free up the resources of doctors and nurses and provide our soon-to-be and just-become mothers with more specialized, focussed and senstive care.

Job well done.

23 comments:

Spinks said...

Mike Murphy took a lot of heat over the idea but really it's that kind of thinking the health care system requires. As soon as the word private and health care get mentioned in the same sentence some draw their swords and cry foul. However something does have to be done. The cost of delivering health care is rising 8 to 10% a year and the revenues aren't. That's unsustainable and some out of the box thinking is a good idea. I know the Liberals cried foul when Bernard Lord's Government amalgamated some hospital services and closed a few small hospitals but I suspect they're breathing a sigh of relief now that the dirty work was done for them so they didn't have to. If renting out surgical rooms when they're empty anyway or having midwives helps slow down the rapid rise of health care, bring it on. The status quo does us no good if it's unaffordable.

nbpolitico said...

the Liberals cried foul when Bernard Lord's Government amalgamated some hospital services and closed a few small hospitals but I suspect they're breathing a sigh of relief now that the dirty work was done

Not entirely true Spinks. The Liberals undid some of the undoable cuts - the Perth-Andover and Plaster Rock hospitals were slated to be stripped of OR services and converted to a health centre respectively this fall but the Liberals, rightly, undid those cuts that would have saved a few dollars in the short term but would have weakened our system and made for higher costs in the short term.

Spinks said...

True, true, true. Perth-Andover and Plaster Rock were a little different due to some unique distance to a centre. However I haven't seen Minto, Caraquet or Dalhousie brought back on-line and the Liberals made a huge stink about those at the time.

With that being said, I have little doubt that if it had been the Liberals who has made those necessary changes, the PC's would also have cried foul. I know, I know, that's politics and heck when you're in opposition you can say whatever you want because you don't make the decisions and then you can hope people forget...well except bloggers. Those Paul Robichaud gems should be pretty good years from now. :)

Paul said...

Spinks is correct. I remember at the height of the debate, when the folks in Caraquet and over in the west were angriest, the liberal MLA in my riding told me the adjustments had to be made and he was happy the PC's were doing it.

You can nitpick about the details, nbpolitico, but sometimes you have to make the unpopular decisons, or so Premier Graham tells us.

As for midewifery, its a no brainer. The more we can remove the physicians from controlling the system the better. If we allowed more access to alternate health care, it would, I beleive, reduce costs.

As for the idea of renting unusable hospital space - particular ORs -I'm all for it. There are problems with those ideas though. For example, the lifespan of that OR will be reduced, and so some money would need to be set aside to compensate for that. I can't see that it would generate that much revenue either.

Real savings is getting rid of some of the bloated bureaucracy in the health care system and the public service as a whole. I'l bet Premier Graham doesn't have the courage for that decision.

Anonymous said...

So... I guess that if your a tory and you say two tier health care you are the devil but if a grit says it, then all is OK

Paul said...

Its because if you are Liberal you can say anything to get elected, and then do exactly the opposite...its been working for them for decades.

nbpolitico said...

Apples and oranges are not the same thing.

You cannot compare the Caraquet, Minto, etc closures to the Perth-Andover and Plaster Rock ones. Why? Because the former were already closed when the Liberals took office and the latter were not.

It is far easier to cancel a planned closure than it is to undo a closure/downsizing that has already taken place. In order to the latter, you would have to rehire/unmove medical professionals, rebuy/unsell the homes they vacated, etc, etc. It is not feasible.

Certainly changes in our health care system need to be made. But it makes me sick to hear people talk about "making difficult choices in health care" as a legacy of Bernard Lord. That is the biggest load of bull I have ever seen.

Lord needed to balance his budget desperately after the 2003 election when he painted an inaccurate rosy picture and promised the world. So they came up with a plan to make cuts in health care.

Was there room for cuts? Probably, but I am no expert. However, I am a realist and I do not oppose sensible cuts. The cuts made by Lord were not sensible and not based on sound policy, they were based on politics.

It does not take an expert to realize that if you are going to start making cuts, you should do it where there is duplication.

However, in most cases, the cuts were in isolated hospitals while hospitals near major centres did not get cut. Why were there not cuts in hospitals like Oromocto and Sackville? Because they were in Tory ridings. But really, that is the first place you should look for cuts, both are around a half hour away from regional hospitals.

Instead the St-Quentin hospital - two hours away from regional hospitals in either direction, with no other facilities in between, was cut from a 12 bed hospital to a 2 bed holding facility. That does not make sense.

Most of the other cuts were similar. Though the Dalhousie hospital, which is in a similar circumstance to the Sackville and Oromocto hospitals, was cut; the difference? It had the misfortune of being represented by a Liberal MLA.

The health of New Brunswickers is not something to play political games with. Cuts should be made based on science, not on future electoral considerations.

Spinks said...

Sackville and Oromocto are a little different. Sackville has a large University and supplies hospital services to the PEI border. Oromocto Hospital could arguably go except for the Military which is based there so there's a critical mass.

Saint-Quentin, I tend to agree should have probably been left alone as long as the proper number of medical personnel could be there. All the bricks and mortar hospitals are useless if there aren't health care professionals to man them. As I wrote I am quite certain the Liberals secretly breathe a sigh of relief that Caraquet, Dalhousie, etc. were dealt with not on their watch. It's political suicide to close hospitals even when it makes sense. The services the Tories brought in with the clinics work very well (ask the folks in Doaktown). The only problem is we need more of that and when people are hooked on having a bricks and mortar full service hospital every 15 minutes, it's difficult to have it all.

Paul said...

All I said was a Liberal MLA was happy they were making the cuts at the time. He seemed to think many were necessary, I tend to agree. It appears to me, NBpolitico, that you think the staus quo was better, and that Liberals don't make political decisons, which is, quite frankly, laughable.

The issue when closing the hospital has as much to do with community identity as it has to do with medical care. PLace is Northern New Brunswick, where I live, are being stripped of their institutions and facilities and they are, for the most part moving south. That is a problem, and it is not partisan.

Did Bernard Lord make political decisions?...yes...were all of them good? .no...Does Shawn Graham make political decision? Yes.. .are they all good? No.

The problem with Shawn, in my humble opinion, is he is not his own man. I see a young man who made some pretty clear promises when he was in the election, and then someone convinced him that he had to change his mind and he lacked the courage of his own convictions. Almost like someone else was telling him what to say.

You can say he had no choice because of something Lord did, but that is just a political way to try and get out of being an honest leader. He is the Premier, after all, and there is more than one way to make the numbers crunch.

There are some really good cabinet Ministers in this government. Kelly Lamrock, Tj Burke, for example, but they have a weak leader, who obviously can be manipulated. That makes me nervous.

You can be as blindly partisan as you want nbpolitico, but Lord wasn't all bad, and Graham ain't all good.

nbpolitico said...

Paul,

I am no blind partisan and I will be the first one to tell you that Shawn Graham and his government are far from perfect. In fact I've called them to task for poor decisions on this blog several times.

However, Bernard Lord was probably as close to "all bad" as you'll ever see in a goverment. You can chalk me up as one of the 60+% of New Brunswickers that cannot name one positive accomplishment from his 7 years in office.

As I like to joke, it was Bernard Lord that recruited me to join the Liberal Party because I would never have joined if it wasn't for his mismanagement of New Brunswick.

Paul said...

NB politico

Okay...if he got you involved that would be one good thing he accomplished wouldn't it?

Anonymous said...

So when exactly did you first join?

Broadcastnb said...

For many people, not being able to remember anything a politician did is a GOOD sign. It means you didn't get screwed as much:) Taxes were lowered, and money in the pocket is a pretty powerful tool.

nbpolitico said...

Paul - LOL you got me there.

Anon - I joined the Liberals either very late in 2000 or early in 2001.

broadcast - Money in the pocket is always nice and every one loves tax cuts, but Bernard Lord's tax cutting mantra meant a few dozen dollars in your pockets and millions of dollars less in the public purse to pay for heath and education. Quite frankly, I would be more than happy to pay my $70 share of Shawn Graham's tax increases in exchange for $50 million in better services.

richard said...

Spinks, where are you getting the 8-10% per year numbers? According to CIHI, the % of GDP for NB spent on health care has gone from 7.6% to 8.6% over the past decade. That does not sound unsustainable to me. "Something" might have to be done, but not a great deal. Perhaps it is the hysteria over health care spending that is unsustainable.

Spinks said...

There's a fair amount of info out there on it Richard (although in fairness I think you're right that it's slowed a little bit recently from the 8 to 10% it was in the early 2000's)

Still here's the line from the 2007-2008 NB budget.

The 2007-2008 budget includes:

- An increase of $127 million for the Department of Health, which is an increase of 6.6 per cent compared to last year.

Revenue isn't going up by the same amount so in the long term it's unsustainable or other programs will have to be cut to make up for it. Something does have to be done because even at 6.6% a year, the bottom would fall out.

Anonymous said...

What Murphy is going rent next? Legislature is free during summer months. May be it can be rented out to private sector.

Murphy does not have a clue what the hell he is talking about. Civil servants are running him by the nose. He is much dumber than you think. I hope health portfolio is given to some sensible individual such as Chris Collins.

richard said...

Spinks:
"An increase of $127 million for the Department of Health, which is an increase of 6.6 per cent compared to last year."

Spinks:
"The cost of delivering health care is rising 8 to 10% a year and the revenues aren't."

Sorry, but that is not really a fair (or consistent) analysis. Readers can go over to the CIHI site and see the data for themselves. There are changes in %GDP spent of health care from year to year, yes, but the 'health care spending is out of control' meme is just a crock. The historical trends do not call for alarm, they call for careful decision making.

Anyone who is calling for major change to avert a "crisis" (i.e. Murphy or anyone else), is either misinformed or has another agenda.

Spinks said...

That's what the government is spending. The revenues don't match the increases. I'll be the first to admit like most people I don't understand all of the bureaucracy and mumbo jumbo accounting that can go on. However in my house when expenses outstrip revenue, I either need to bring in more money or cut expenses somewhere. The revenues aren't growing 6.6% a year.

If the government is spending more, something needs to get cut or taxes need to increase if this continues. It has shown no signs of abating up until now. I fail to see the "crock". It's simple math from where this taxpayer is sitting but perhaps I stand to be corrected.

Anonymous said...

Hey Spinks, may be you can rent out kitchen and one of the bedrooms in your house to cover additional costs. If you have children buy them bunk bed in order to have one bedroom available for rent. Or you and your spouse can sleep on couch. Or use the bedroom and kitchen in shifts - surely you are not using the bedroom and kitchen all the time.

Learn something from the genius Murphy ;)

richard said...

"It's simple math from where this taxpayer is sitting but perhaps I stand to be corrected."

Yes, it is simple math; you just have to spread costs out over a series of years. Again, I suggest you visit the CIHI website. In one year, if memory serves, health care spending went up 18%, a year or two later, health care spending was -3%. Increases or decreases in one budget don't mean much; there has to be a trend over several years. The trend provincially and nationally is fairly stable.

"The revenues aren't growing 6.6% a year. "

But revenues are growing as GDP goes up. Or, in the case of homeowners, as income goes up. It is only if incomes are stagnant that increasing total costs (in excess of income) are a problem. And then it is a question of how much debt load you are willing to bear.

Spinks said...

Naw anon, I'm saving the kitchen for Charles Leblanc. He has first dibs. :)

Anonymous said...

Spinks, let Charles Leblance and Mike Murphy share your kitchen ;) They are great fan of each other and buddies ;)