Showing posts with label T1. Show all posts
Showing posts with label T1. Show all posts

Tuesday, December 21, 2010

GM1-12

In reply to Metasphere http://cmatalks.blogspot.com/2010/12/gm1-10.html

I don't believe that physicians do not want to see more physicians trained. However, there are gluts in some specialties and shortages in others. We are short of family doctors and so there should be family medicine programs whereby the entrants become family doctors. The University of Calgary is piloting just such a program.

http://sitelife.theglobeandmail.com/ver1.0/gocomm?ck=CommentKey%3a9390ef97-278f-4fb1-80f4-2dd141c2fb83

GM1-11

In reply to Metasphere http://cmatalks.blogspot.com/2010/12/gm1-10.html

I would agree with that but there has to be a certain acceptance criteria that a percentage of those new applicants will move to reomote, or rural areas that are sorely lacking in family doctors. Most new docs want to stay in heavily populated urban areas.

There's a doctor shortage crisis in non-urban areas of Canada.

GM1-10

One thing I would do is triple med school enrollments.

But the doctors won't want to hear that.


Saturday, December 18, 2010

T1-86

In reply to wgrichardson http://cmatalks.blogspot.com/2010/12/t1-60.html

wgrichardson

Somewhere in the talking and hearing using the English language people have to have the same definition for the same words.
e.g. when we hear " scope" we immediately think of it as meaning ( breadth or opportunity to function) as if it widens the multiplicity of our opportunities

In reality the payor is looking for " economies of scope" which essentially means fill up the vehicle with all of the different items you are buying, so you will only have to make one trip and thus reduce cost.

Many people think it means economies of "scale" where you simply plug several outlets into "bulk" purchasing power

Ideally the two would exist in harmony.... versus separately

Therefore, getting reduced usage by the patient is not the problem.
Getting ?reduced/wiser usage of the ?system by the medical practitioner/supplier is the answer.

http://www.healthcaretransformation.ca/en/topics/view/id/1#comment-86

T1-82

In reply to wgrichardson http://cmatalks.blogspot.com/2010/12/t1-60.html

You say that "A lot of them however cannot be addressed by the CMA" - but they can be advocated for by the CMA. It is not any single organization's or government department's responsibility to tackle - it is our collective responsibility and takes much "outside of the box" thinking and commitment to change political will.

http://www.healthcaretransformation.ca/en/topics/view/id/1#comment-82

T1-158

In reply to Purley http://cmatalks.blogspot.com/2010/12/t1-117.html

RE: +train the physician to perform in this arena in a "Z" structure under his/her management

Is is worth explaining that the vertical line is the physician as the knowledge worker connected to the " system" ( the top horizontal line) and his/her client base ( bottom horizontal line)

Technology has birthed the necessity for the TOP horizontal line to connect DIRECTLY with both the non-medical care provision needs of the client/patient AND for the physician to connect directly with IT related to funding for primary care services.

It is the purview of the physician to grow into how he/she performs as mainly a knowledge worker assisted by technology to serve a larger client base. It is the traditional role of the physician to lead the development of the BOTTOM horizontal line where medical provision of services is delivered.

It is the responsibility of the payor to update/create legislation that governs the TOP horizontal line.

It is the responsibility of the physician to justify to his investors ( government and client payors) how his practice meets their requirements.

This TOP horizontal line is where the " feeding frenzy" is ........... PRIMARY care

Note:

The vertical line of the physician is oblique ...where the patient accessing the physician from a top down approach does not necessarily connect with medical care as a first step.
[This position must also be supported by an algorithm]

Therefore in order to access the physician directly the patient is bypassing the topline already and going straight to guaranteed access to physician care....i.e. SECONDARY care levels

This secondary care level is in it's first stages of restructuring to embrace the client/patient who refuses to use the jumble of primary care portals .
[politicos better hasten to adjust this structure into "program cells that float in a medium" in order to prevent rapid escalation of cost in secondary care levels ]

Who will clean up the TOP horizontal line?... it must be the politician..... not the physician.

KEY: It must ultimately be structured so it's success can compete internationally as " care" offsets become as valuable as " carbon" offsets in trading value.
It is the TOP line that deals with the " dependent" variable...which is NOT the client/patient... is NOT medical care.....
IS..... the service delivery structure itself.

http://www.healthcaretransformation.ca/en/topics/view/id/1#comment-158

T1-117

In reply to Purley http://cmatalks.blogspot.com/2010/12/t1-86.html

continued....

It is worth considering what you do when experimenting.
You have dependent and independent variables and you measure the unknown against the known.
The mistake made in planning, structuring, delivering, medical health care is the costing focus is on the unpredictable...versus the predictable.
When a patient is institutionalized the stable costing components are on the non-medical components of care. The elements that can be predictably costed, staffed, and improved over time .
It is the funding of the NON-medical components of health that will stabilize the SERVICE environment for the patient/client.

It is the funding of the physician ( not overriding umbrellas clustering private ambitions) that will stabilize the funding environment for the payor. To effect this the physician must adopt a system that enables him/her to perform as a KNOWLEDGE worker ... not simply a prescription writer in someone else's stable.

Face it......... if you remove the physician and the patient form all of these struggles........ the entire remaining structure has no purpose .... and it falls to nothing.

How to do this?
+Seperate primary care totally from the three other levels ( secondary, tertiary, quaternary).
+Fund direct patient/physician interraction at the secondary care level ( hospital setting )
+Let the primary care level learn to stabilize it's function based on HOW they deliver the STABLE components ( non-medical services)
+train the physician to perform in this arena in a "Z" structure under his/her management
+establish a predictable service package directly connecting frontline workers to client/patient

http://www.healthcaretransformation.ca/en/topics/view/id/1#comment-117

Friday, December 17, 2010

T1-60

In reply to Ishmael http://cmatalks.blogspot.com/2010/12/t1-3.html

yes, you have very good points. A lot of them however cannot be addressed by the CMA. Unless of course they recommend a reduction in Health funding to allow an increase in other relevant areas for health status that do not include clinicians or medical services.

Your list: Some are educational policies, others are social programing, then there is food/corporate taxation and environmental policy. Right now we do not appear to have the political will irequired to provide this shift in funding or policy. For example, David Butler-Jones (Public Health Agency) submitted a report last year to the federal government endorsing the social determinants of health- it did not see the light of day. Why? Politically unpalatable.

I think you are bang on for the path to a sustainable society and with it a sustainable health care system due to reduced usage. It is a matter of convincing politicians to implement the financial shift of funding from health care to other important areas that also influence health status. I say shifting as health care consumes the lion's share of funding in all provinces. We have a finite amount of resources and most other departments have had reductions due to increased spending for health care.

http://www.healthcaretransformation.ca/en/topics/view/id/1#comment-60

T1-455

In reply to Kenneth http://cmatalks.blogspot.com/2010/12/t1-38.html

Not sure why people have given your post thumbs down. Those are great ideas!

http://www.healthcaretransformation.ca/en/topics/view/id/1#comment-455

T1-38

In reply to Ishmael http://cmatalks.blogspot.com/2010/12/t1-3.html

The economy depends on new ideas, inventions to save resources or for trade. Inventors need help to afford patenting costs and a faster system to enable hospitals , industry and inventors to match each others needs or demands.

Each operates independently. Inventors think of inventions but not always 100% adaptable for the demands of others.

Eg . fire proof clothing for firemen but the same materials for children clothing who may get near hot stoves, so burns occur, while a sewing firm may not have seen the need but needs to diversify.


Better lever wheelchairs that are affordable so disabled do not need a driver to go a few blocks, get exercise so no obesity due to lack of exercise by depending on electric wheelchairs.

Better beds etc...

Hospital foundations should change their focus to ask patent agent lawyers to help inventors of medical devices, biological see CIPO, Industry Canada. There are a lot of funds if the invention comes from a university or a hospital but not for simple individuals who may have medical device ideas...

Inventions are not limited to the strict sense of a disability but ideas that enable them more independence in all daily activities. eg ideas that have functions for the non disabled and for industry,

eg better beds for homes and for travel. I do not want to hint of ideas, but ideas for mass production rather than a closed custom market specific to any disability.
Kenneth Hilliam writekenneth@hotmail.com

http://www.healthcaretransformation.ca/en/topics/view/id/1#comment-38

T1-3

This is a troublesome road to go down, because it cements and increases the role that large pharma has on our health care system.

It is critically important for everybody to understand that large pharma has no interest in making being healthy; the financial incentives in this system encourage drugs to be created that manage symptoms of illnesses, without actually curing the underlying problem. If the treatment has another side effect that requires further treatment, that's even better from a corporate financial bottom line POV.

Research into true cures need to be publicly funded without corporate interference so as to make sure they are as widely available as possible. Natural treatments that are easily accessible to all should be researched first, as opposed to artificial and expensive pharma drugs.

The most important part of any observation/revamp/examination of the health care system is keeping people healthy in the place, not treating them with drugs when they start to get unwell.

And there are so many, many things that need to be addressed in our society in order to keep people healthy:
- encourage physical fitness through proper urban planning and creating walkable communities, largely serviced by superb public transit and alternatives like biking and cycling
- discourage the ingestion of unhealthy food-like products through financial incentives (the more a food is processed and has unhealthy salt, sugars, chemicals added to it, the larger the tax on it - these taxes could be used to subsidize healthy, unprocessed foods)
- hard limits on the garbage they add to food like salt, fructose, refined sugar, etc
- improved nutritional teaching in schools, including preparation of healthy meals
- full support for physical fitness in schools, with lots of after-school sports, gym, etc.
- only serving healthy options in schools.
- adopting a precautionary approach when it comes to chemicals, pollution, radiation in our environment - if the company can't prove it's safe, then it shouldn't be used/ingested.
- helping people understand that health does not start with a pill, and how important it is to control what we take into our bodies and the effect that it has.
- teaching parents how important nutrition is for children in every aspect of their life. I see so many parents giving their kids complete junk as lunch and snacks, not having any idea how much damage they're doing to their children.
- ensuring companies that create huge social costs, like cancer and obesity, pay the price and that we don't subsidize them at the cost of the average person's health.
- changing the way doctors treat patients in order to give them enough time to holistically understand someone's health picture and help them get healthy, and identify potential issues at the earliest possible time. Right now, 7 minutes per patient visit, one at a time, only perpetuates a system of treatment with drugs, and having serious illnesses routinely missed until they become quite serious.

These types of changes will have a more profound and lasting effect on our society, at an overall lower cost, than lining the pockets of big pharma for expensive illness treatments for problems that other industries, and our own collective ignorance, have created.

The bottom line is that we have a finite amount of resources. I would greatly prefer to invest those in the front line of keeping people healthy, rather than at the back end where big pharma has a goal of keeping people not quite sick enough to die, and on as many medications as possible.

http://www.healthcaretransformation.ca/en/topics/view/id/1#comment-3

T1-444

In reply to Rose http://cmatalks.blogspot.com/2010/12/t1-6.html

And also way behind regarding dental care. It is unbelievable how expensive this service is in Canada. Many people rather paying for it abroad. It is ok to pay well to people who have spent years and money studying but it is not right that in a developed country as Canada, there is such a high number of people without teeth or with so much dental problems because they can not afford the service.

http://www.healthcaretransformation.ca/en/topics/view/id/1#comment-444

T1-355

In reply to Rose http://cmatalks.blogspot.com/2010/12/t1-6.html

I agree. eye glass frames are way way over priced for what they are made of given the massive number they sell. Some one is making a colossel profit.

The actual design and production of frames is simple and given technology fast. Even the production of the glass/plastic eye pieces is pretty cheap these days given the automation provided by machines.

http://www.healthcaretransformation.ca/en/topics/view/id/1#comment-355

T1-439

in reply to Wayne http://cmatalks.blogspot.com/2010/12/t1-298.html

Perhaps there are a lot of options where you live but we are not all so lucky to have thrift stores that carry such items.

I live in a remote area and on somethings its a take it or leave it situation, and even reusing my old frames I'm still over $400.00 because of the price of my lens cost me. Other areas might sell for less but by the time I travel there I'm right back to where I started,so my options are few to none.

http://www.healthcaretransformation.ca/en/topics/view/id/1#comment-439

T1-298

In reply to cwilliams6009 http://cmatalks.blogspot.com/2010/12/t1-224.html

Yes you can buy the frames for a very reasonable price. Its the lens for the glasses that are high priced. They generally run $150-$300. depending on whether or not they are bi-focal, tinted etc.

http://www.healthcaretransformation.ca/en/topics/view/id/1#comment-298

T1-224

In reply to Rose http://cmatalks.blogspot.com/2010/12/t1-6.html

Excuse me, $400 for a pair of glasses? Where are you shopping? You can buy cheap frames for $50-10, or less at a thrift store. There's lots of options out there.

http://www.healthcaretransformation.ca/en/topics/view/id/1#comment-224

T1-414

In reply to Rose http://cmatalks.blogspot.com/2010/12/t1-6.html

In B.C. not only are eyeglasses not covered, eye examinations are not covered even for a diabetic (leading cause of blindness). I've found for prescription sunglasses any frames will work, even my husband's larger size frames.

http://www.healthcaretransformation.ca/en/topics/view/id/1#comment-414

T1-6

Rose in reply to Jennifer http://cmatalks.blogspot.com/2010/12/t1-2.html

I so agree, my little granddaughter was sick and the prescription she needed was not covered by BC's healthy kids program and her mom is disabled with little money for extras so we had to help her again. So far we've had to pay for the little ones eye glasses and now 5000.00 for braces. we are not rich and the money we are using was for our retirement. And I hate to think of others that don't have this much support. Our country is far behind, too far behind. And for the life of me I can't understand why we can't get yearly medicals. You'd think preventive care and catching any major issues with ones health, might be less money to treat than waiting till it becomes a battle.

http://www.healthcaretransformation.ca/en/topics/view/id/1#comment-6

T1-2

Prescriptions and Eye Glasses...now sure about you, but I sure can't afford Glasses when they go at 400 a pop. I think Eyes are a necessity of life, without being able to see you sure can't work or do anything, so I never understood why there was no glasses coverage or optical visits coverage. UK fully pays for their people's prescriptions, eye visits and glasses......our country is so far behind!

http://www.healthcaretransformation.ca/en/topics/view/id/1#comment-2

T1-1

I think our healthcare system should have started paying for prescriptions long ago. Just recently I had a persistent cough for almost two weeks. I work with the hearing impaired and I need to raise my voice for most of the day, however even talking softly would trigger a coughing fit. My doctor had written me a prescription for a supressant, however it cost nearly $75! Finally I couldn't deal with the coughing anymore and was forced to pay the prescription. I don't understand why my doctors appt to get the prescription was paid for, but the medication I needed afterwards was my responsibility.

I also think our dental expenses should be covered. Even just regular cleaning! Dental is way too expensive for those without insurance.

http://www.healthcaretransformation.ca/en/topics/view/id/1#comment-1