October 2002
Seniors Advocate
How can you know if our health care system is well managed and working well!
By Dr. David Zitner
Seniors and all Canadians strongly value and appreciate many government activities. Perhaps this is the reason we don’t resist too much when asked to pay high taxes.
However, we expect governments to deliver good value for the dollars we donate for government and communal activities. In health care good value means that we don’t have to wait too long for health services administered by government insurance, and that the health services we get help us and don’t harm us.
Recently at least one district in Nova Scotia reported a failing grade for emergency department access. In the Capital District 88% of patients, with a category 3 emergency, waited longer than the accepted standard. What other questions should Canadians ask in order to understand if our health care system is being well managed or not, if it is succeeding or failing us when we need it most.
What does helping mean in health care:
The purpose of health care is to improve health, in particular to improve our comfort, our function and how long we live healthy lives. People see a doctor, nurse, physiotherpist or other health worker in order to feel better, to be able to do more, and to live longer. And, it is reasonably simple to measure if an individuals function or comfort increased after a treatment. In fact, it is so simple that each of us (with or without health care training) knows after treatment if they feel better or if they function better and are able to do more.
Are our health care dollars well managed and do we receive good value:
So, how can Senior Citizens and other Canadians know if we are receiving good value for the dollars government spends on our behalf? One way is to ask politicians and health care administrators what we are getting for the money they spend, on our behalf.
We know that many people who receive treatment have miraculous recoveries! How many? We also know that some treatments could be harmful. How many? Do those managing our health care system make the right measurements? Do they know how many people are helped or harmed? Does the health care system report the results to us?
We also expect health care to be there when we need it. Being there when we need it means not waiting too long. Health system administrators should know exactly how many people are waiting for care and how long they have waited, and how many are waiting too long.
As an experiment each of readers might consider asking your local community or district health board or Provincial M.L.A. if they know how much money was spent for health care, and asking if they know how many people benefitted from treatment and how many were harmed? Does your district board have a list of all people waiting for care and how long they’ve waited? How many have waited too long? Does your M.L.A. know and understand how the health care system is functioning for his or her constituents?
Developing infrastructure-for example roads and sidewalks- is an important government activity. Encouraging the development of an INFOstructure (the information tools to support health care and health care management) is one example of an important government role in health care.
When the proper information infrastructure is in place perhaps our health system will be better able to answer your important questions.
Four questions to ask to find out if our health care system is working well and well managed.
The Questions!
1. How many people are better after treatment?
2. How many people are worse after treatment – and who are they?(How often do mistakes occur?)
3. How many people have to wait too long for care?
4. Can your Minister of Health, Provincial M.L.A. District Board Chair, or District Board CEO answer the first three questions?
Are there other questions about the health care system you would like answered? The system will only get better if you ask the right people the important questions.
Dr. David Zitner, a family doctor, is Director of Medical Informatics at Dalhousie University Medical School and Health Policy Fellow at the Atlantic Institute for Market Studies
