We all have Alzheimer’s when it comes to health care

Each time I go to a medical clinic, it’s like they don’t recognize me and have never seen me before.  And the hilarious part is I don’t know them either.   This is not a huge problem as I’m an extravert and make friends easily.  However, I really do feel strange asking someone I don’t know to give me a prostate exam but that’s your life when you don’t have a family doctor.

Today, I can’t say the health system is working for me.

The documentary by Michael Moore entitled “Sicko” compares the health systems of the US, Canada, the UK, Cuba and France.   Moore’s analysis makes for good entertainment and perhaps opens the eyes of a few American viewers on the deficiencies of their health system.  His portrayal of the Canadian system is generally on the mark although there are inaccuracies with emergency room wait times and access to primary care.

Statscan figures show that 8.2% or 61,500 New Brunswickers don’t have a family doctor.  We presently have 700 family doctors or 1 for every 983 people.

The Minister of Health Mike Murphy plans to hire another 15 doctors, which would be 1 doctor for each 4100 of the 61,500 citizens presently without medical representation.  Hey, what’s wrong with the math here?  Are we hiring enough to solve the shortage or just enough to lower the political heat?

The annual health budget for New Brunswick is $2,933 per person or $2.2 billion.  As a country, we spend about 9.8% of the Gross Domestic Product (GDP) on health care (NB is 8.8%).  We’re in the middle of the pack when looking at what some countries spend; Ireland –7.2%, France – 11.1%, Germany – 10.7%, with the US being considerably higher at 15.3%.

What has concerned all national governments over the years has been the continual increase in the cost of health care above the rate of inflation.  In other words, the health budget chews up more of the government revenue leaving less for other departments.  The US system is trending towards 20% in coming years and I don’t think that country or New Brunswick can or will accept costs of that magnitude.

The increase in costs comes from more high technology (MRI’s, etc) and what is often called “mission creep.”  That’s a change in our expectations of what the system can provide.  Only a number of years ago, open-heart surgery or hip replacement wasn’t that common.   Longevity of people is on the rise and a significant portion of the budget is spent on people who will live less than a year.

Even though the Canadian system has a lower cost due to reduced administration, it is encouraging to see the Health Departments 2008 – 2012 plan.  It’s a road map for providing better health care with less cost.  A notable initiative is the use of computer technology to manage patient care (one patient, one electronic record).
Consolidation of regions and non-clinical services should provide less back office cost and focus money back on patient care.  This saving is approximately 1% of the total health budget or $20 million per year.

It appears that efficiencies can give us some respite in increasing costs, but it will not be enough.  Are we prepared to set an upper limit on our health costs to perhaps 11% of GDP?  That would be another $550 million per year in New Brunswick.  It might eliminate wait times for surgery, provide more MRI’s and the like, but what else in the overall provincial budget would we cut?  Or would we be prepared to raise taxes to live longer, healthier lives?

But perhaps our future won’t be increasing budgets for health care but cutting them.  The fragility of our financial system to something as ridiculous as sub-prime mortgages shows that the economist’s assumptions of perpetual growth is not entirely certain.  The decline of the world’s commodities like oil production in the near future will have a profound effect on GDP.  It will shrink the tax base that supports the health care system we so cherish.

Should we be planning for a future that is less rosy than the optimists of this world predict?   As an aside, there are 45 million Americans who could be looking for a family doctor in Obama’s insured world.  Maybe I’ll get a doctor before they come looking for 45,000 doctors north of the border.  I doubt they’ll be talking to Raoul Castro about Cuba’s surplus medical talent.

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