Funding our Health Care System

Sometimes the timing of things simply amazes me…

Once again, I was reviewing my daily list of websites when I saw this article titled:

“Patients are Dying in Hospital Corridors”

The article can be found by clicking here to link to the website.

The points in the above article are not startling to anyone who has worked in the UK healthcare system or the Canadian healthcare system… both socialized systems suffer from the same malaise. What was amazing to me was the fact that I had the blog below already written and was only waiting to publish it, to find someone else had the same blog in mind.

Just in case it is not universally known… our provinces health care system has one budget that has to spread around and shared by all those in the province.

Simple concept, but not so simple in execution because the state of health of the entire population of a province isn’t something that fits nicely or easily into a ‘budget’. For example, if there is a break out (e.g. SARS) then a hospital’s budget for an entire year could be blown in a matter of weeks because of the demand placed on it by an emergency situation.

As residents of Ontario, we expect and want health care crises (e.g. SARS) to be contained and dealt with, BUT the reality is that someone (i.e. taxpayers) have to pay for that… but taxes and budgets are set out well in advance.

With that said though, the point of this post is not to identify one time issues, but how annual budgets are wasted, and how incredible amounts of time and energy and effort are wasted in order for health care facilities and professionals simply to get reimbursed for the work they do, day in and day out.

Awhile back a new billing thus funding system was introduced to Long Term Care facilities (aka nursing homes) in Ontario. The way the system worked was based on how front line staff, as in PSWs (personal support workers) and the registered nursing staff coded their efforts during their shifts. How the facility staff documented their interactions with the facility residents changed how much the nursing home would receive in the following budget period.

Let me remind you… there is only one budget in Ontario, and it is shared by all… so if one organization gets more…. surprise, surprise… someone else has to get less.

So, imagine what happens when long term facilities figured out that they can get “more” funding based on how they document the health care, staff provided. They figured out rather quickly that if they documented (i.e. code treatments) into the system in particular ways they could trigger certain criteria points that would cause their facility to get more funding based on the data that showed they were delivering “more” care.

The resources piled into ‘gaming’ (exact words of the Ministry of Health staff charged with implementing MDS RAI) the funding system for Long Term Care facilities was unimagineable – especially to the Ministry of Health!  Seriously.  The Ministry of Health could not predict that for-profit health care corporations operating long term care facilities in Ontario (e.g. Chartwell, Extendicare, Revera) would be eager to extract as much of the budget for themselves.

Yeah… like it takes a real rocket scientist to figure out that a for-profit company is interested and would be highly motivated to maximize revenue, hence profits if and when the opportunity arose… nope, couldn’t see that one coming. Where is Will Ferrell when you need him?

Imagine what happened across corporate boardrooms all over Toronto when this loophole was discovered… hundreds of long term care facilities figuring out all at once that if they weren’t coding in certain ways, but others were…  and then there was a sudden shift in the force as everyone realized all at once that if they weren’t blowing the Ministry of Health’s budget for long term care spending, someone else was!  It became a free for all as everyone went all-in on figuring out how to maximize their own cut of the budget pie.

This is our health care system in a nutshell and just another reason why despite anyone’s promises – especially politicians and health care experts called in to propose solutions – fixing the system so that it is fair and works all the time for everyone is not only unrealistic, its impossible.

If the funding fiasco which was the MDS RAI project of Long Term Care facilities irritates you, then you will not want to hear that the entire system basically works in this way…

Wonder why CCAC’s hire health professionals in abundance in April and start firing as early as the early winter? Its because April 1st marks the beginning of the Ontario health care budget. At that point in the year everyone is awash in cash. That lasts thru the summer until about December which is approximately the time CCAC budgets start approaching their limits.  Fewer appointments are made available, fewer follow ups are available, fewer therapists are on hand as budgets are almost entirely spent. Next April 1st the cycle starts all over again.

Seriously! It absolutely does matter when in the calendar you get sick, because when you get sicks determines how much money is left in Ministry of Health budgets which has a direct connection to surgery wait times, on the availability of doctors, nurses, therapists, as well as hospital beds, not to mention how much follow up care you can expect.

It all comes down to budgets, and since budgets are finite the reality is that the amount of health care that can be delivered is equally finite in any given budget period.

Anyone selling you on the illusion that our or any health care system is limitless, or that there is a way to structure any health care system so that every single person of the population gets every type of care they need, when they need, in limitless quantities… is likely a politician.

No one in the system discusses the reality of the system because either they are profiting from the system as it stands (i.e. those working in the system), or they make their living selling that the system’s issues are the fault of the opposition party and if they were only made the governing party all would be resolved (at least this time around… unlike last time when the same promises were made but nothing changed).

The reality is… for the first few months of every budget year everyone is on a tear to blow as much of their allotted amount of the total provincial health care budget as quickly as possible because the more they blow, the more revenue and profit for them, and the less for everyone else. The fact that this “tear” to spend the budget ripples throughout the entire province negatively impacting the delivery of health care year after year is the elephant in the room which is working its way to bankrupting the entire system (that is unless taxpayers want to continue to bankroll the budgets to endless heights).

Funding issues exist in all realms of our health care system.

Doctors face their own caps, clawbacks, and limitations, so if you wonder why they are at time unavailable, perhaps only able to see you so many times a year, more often in one period and less often in others, etc… well don’t be… it comes down to budgets.

Medical labs face the same issue… they have budgets to, and believe it or not, there are only so many samples (e.g. blood tests) that can be taken and analyzed when you have a budget.

Name the aspect of the health care system that you need… and guess what… same thing. The level and amount and speed of service depends on…. how much has already been spent on other Ontario residents before you show up with your health issues.

The easy targets in this arrangement are the health care professionals who are hamstrung by their professional obligation and responsibility to deliver health care but often do so knowing that they are giving of their time, their energy, their expertise while the chances of them being actually appropriately reimbursed – and in a timely manner and without risk of clawback – may be 50% at most. Consider that next time your doctor, your nurse or therapist is stressed.

No, its not an excuse for health professionals not to be professional… but consider the fact that over time… not knowing if you are going to be paid, or when, or how long the delay in payments will be this time wear on even the most professional. Health professionals are no different… they have mortgages and car payments, and need to buy groceries and enroll their kids in programs.  My apologies… I digress from the point of this post.

Next time you are frustrated with the health care system… I suggest instead be frustrated with yourself because clearly you are sick or had your accident at the wrong time of the year (as in budget year).  Next time, make sure you are sick, have your accident or need that surgery or emergency care in the early part of the health care budget season… as in April-October because you can be at least somewhat more certain of getting the care you need.

Don’t like that option… then there is another. Take your health and well being into your own hands, and stop depending on a system which is NOT designed to be there when you need it to be there when you need it. Instead of having to learn the hard way… start to eat right, get enough sleep, exercise appropriately and smartly (i.e. no HiiT), and start to eliminate all unnecessary stressors and stresses that prevent you from living in health.

The unfortunate reality is that our health care system is designed to exist only enough to make it seem as if it is there. Catch it at the right time… and it may be there for you, catch it at the wrong time… and your health will be your problem, just yours because there isn’t any more budget in the system for you.

Oh, forgot to mention one other tool of the Ministry of Health in managing budgets…

FYI… when the MOHLTC wants to eliminate a budget for some specific aspect of the health care system, they make the funding available for that service so low that it becomes uneconomic to deliver it in the reality of the current marketplace (i.e. rent, staffing, office expenses, etc…).

In this way, the MOHLTC can say it does indeed offer and fund that service… BUT because the actual delivery of a service is the duty of health care professionals, the MOHLTC has the easy out that the lack in the system is due to a lack of health professionals or a lack of health professionals available to deliver that service.

Trust me… it works great to de-incentivize health professionals to deliver health care services: offering pennies to deliver what requires dollars will eliminate that specific service in no time flat.

So… there you have it.  Wanna be one of those dying in hospital corridors?  Wanna be the one that gambles with their health, their life, relying on a strategy of ‘hoping’ that the health care system will be there – and fully funded – when you need them, when you are in need? Go right ahead, but just don’t complain while you await hour after hour in the corridor for a doctor, or a scan, or a test, or a nurse.

Trust me when I tell you to take your health into your own hands and become as healthy as you can, so that you, your family, your kids, anyone you love and care for needs the health care system is as little as possible.  Its called managing known risks well in advance.