How to keep shiny new ORs open, and help save healthcare too

'What's important is when those facilities are available - if they shut them down at 4 o'clock, that doesn't make much difference... Get rid of the bureaucracy, open the theatres, get rid of the waiting list." - UBC professor Dr. Pat McGeer (CBC.ca, Feb. 10, 2017) Dr. Charles ShaverDr. McGeer was referring to the announcement that the Vancouver General Hospital was to add 16 new operating rooms. However, most ORs in British Columbia are closed after 4 p.m. daily and on weekends.It is ironic that across Canada, provincial and municipal politicians are always present for photo-ops when new ORs or wings of hospitals open. They are strangely absent when ORs quietly close for longer periods of time to balance frozen global budgets. The result is that nurses are laid off and elective OR time for surgeons is further cut—with predictable adverse consequences for patients and health professionals.Many of these nurses and MDs eventually leave Canada—a huge waste of their training. For example, Dr. Robert Hollinshead found that 80% of residents from his Calgary residency training program left for the U.S.At the same time, healthcare coverage in the U.S. is in limbo. If Canada could help to solve the problem of providing healthcare to Americans at an affordable cost, this might improve the climate for issues such as NAFTA renegotiations.Canadian Prime Minister Justin Trudeau and U.S. President Donald Trump initially met on Feb. 13. Alberta Premier Rachel Notley is to travel to Washington, D.C., this month to promote Alberta and highlight existing trade ties.It makes sense for the U.S. to look to Canada for a way to more efficiently cover elective surgery, such as joint replacements on some of its patients.Some provinces have still not signed a health accord with the federal government. However, most are running a deficit, and Ottawa itself projects one of $30 billion. As there is but one taxpayer, it does not make sense to argue over the exact amount of transfer payments. To be fair to taxpayers, patients and health professionals, we should be creative and find new sources of revenue. This requires amending and modernizing the Canada Health Act (CHA).Frustrated by long wait times (as documented in a recent Conference Board of Canada-CIHI survey), and often in severe pain, some Canadians go to the United States for diagnostic and surgical procedures, thereby giving profit to U.S .hospitals and employment to their health professionals.In Canada, admittedly there has always been a "two-tier" system. In fairness to those not in special groups (athletes, politicians, members of the military, etc.), the CHA and various provincial laws should be amended to allow all persons to spend their discretionary income on their own health in their own province.If orthopedic surgeons were given access to additional "private" OR time, and the operating rooms were run on a 24/7 basis, wait times could be shortened for all.To guarantee that they did not abandon the public system, they could be required to work a certain number of hours per week so as to retain their government-reimbursement for malpractice insurance. In addition, the CHA should be amended so as to mandate binding arbitration so that MDs would be fairly remunerated for their work in the public system.Now is also an opportune time to consider offering elective surgery to Americans and other foreign patients. A joint replacement can run up to $74,000 (U.S.) in Boston. Meanwhile, a private clinic in Laval, Quebec charges only $18,000 to $19,000.President Trump has urged his constituents to "Buy American and hire American." Yet he also pledged that healthcare would be his number-one domestic priority. Newly confirmed Health and Human Services Secretary Dr. Tom Price will be seeking cost-cutting measures for Medicare patients. So will private insurance companies. With a 75-cent Canadian dollar, it would be financially attractive to send some American patients to Canada for their elective surgery. All provinces should cover all additional costs of malpractice insurance for these foreign patients, and then recoup them from Washington and U.S. insurance companies. Thus, there would be no adverse effect on the Canadian Medical Protective Association.It would truly be a "win-win" proposition for politicians and patients on both sides of the border.By modernizing the CHA so as to permit a limited amount of "private" medicine, we could provide new employment for nurses, technicians, and MDs. There would now be extra revenue to would help relieve to the present financial strain on hospitals, and on provincial and territorial ministries of health. Our public healthcare system would then become sustainable.Ottawa physician Dr. Charles S. Shaver was born in Montreal. He graduated from Princeton University and Johns Hopkins School of Medicine. He is chair of the section on general internal medicine of the Ontario Medical Association. The views expressed here are his own.Opinions expressed in this article are those of the writer, and do not necessarily reflect those of CanadianHealthcareNetwork.ca or its parent company.

How to keep shiny new ORs open, and help save healthcare too

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