Bit­ter medicine

Advertiser (Grand Falls) - - Front Page - Russell Wanger­sky Russell Wanger­sky’s col­umn ap­pears in 39 SaltWire news­pa­pers and web­sites in Atlantic Canada. He can be reached at russell.wanger­sky@thetele­ — Twit­ter: @wanger­sky.

Some­times keep­ing health care healthy is go­ing to hurt

Mess with health care — es­pe­cially if you’re clos­ing hos­pi­tals — and you’re bound to get a re­ac­tion. That’s ex­actly what Nova Sco­tia Premier Stephen McNeil got on Mon­day when he an­nounced that two Cape Breton hos­pi­tals were clos­ing, and that two other hos­pi­tals would be en­larged to take over care for the closed units.

The changes in­cluded clos­ing North­side Gen­eral Hos­pi­tal in North Syd­ney, a hos­pi­tal that open­ing in 1954, and New Water­ford Con­sol­i­dated Hos­pi­tal, which opened in 1964. The plan is to re­place the hos­pi­tals with col­lab­o­ra­tive health cen­tres, but both ar­eas will lose their emer­gency rooms. In some ways, that’s not sur­pris­ing: the two hos­pi­tal al­ready suf­fered from doc­tor and other staffing short­ages that led to the two emer­gency rooms be­ing among the top three most­fre­quently closed emer­gency rooms in that province.

It would be easy to ride the public out­rage wave, and sim­ply say that the clo­sures were un­fair and de­mand that the gov­ern­ment ought to over­turn them.

But the truth is that, across all four Atlantic prov­inces, health care is the sin­gle most ex­pen­sive item in any provin­cial bud­get. In fact, health care is far and away the most ex­pen­sive ser­vice that provin­cial gov­ern­ments have to fund. And the costs are ris­ing ev­ery sin­gle year.

If we don’t give our provin­cial gov­ern­ments the lee­way to make changes — some­thing that seems es­pe­cially the ca­sein the Cape Breton, where the hos­pi­tals be­ing closed are rel­a­tively small op­er­a­tions in dated builds, and in ar­eas like ru­ral New­found­land as well — we’re not go­ing to be able to af­ford care.

Emer­gency rooms are among the most ex­pen­sive ser­vices to pro­vide —- they are fully staffed with spe­cial­ized staff 24 hours a day, and that staffing is re­quired even if there aren’t pa­tients to care for, and even if, in the case of ar­eas with short­ages of fam­ily doc­tors, highly trained emer­gency medicine spe­cial­ists are deal­ing with a long lineup of mi­nor ail­ments, from colds and flus to ear in­fec­tions in chil­dren. Emer­gency rooms cer­tainly have to be close enough to help pa­tients who need ur­gent care, but they also have to have enough pa­tients to make their sub­stan­tial ex­pense worth­while.

We have to be more strate­gic about how we spend health­care dol­lars: some health-care sys­tems, for ex­am­ple, are set­ting up sys­tems to en­sure their di­ag­nos­tic imag­ing ser­vices are used to the fullest, en­sur­ing that pa­tients are con­tacted in the days lead­ing up to their ap­point­ments, and if ap­point­ments are can­celled, fill­ing those spots with peo­ple from a read­ily avail­able wait list in­stead of sim­pler let­ting equip­ment and trained staff sit idle.

It’s worth think­ing as well that, when hos­pi­tals like North­side and New Water­ford were opened, the en­tire med­i­cal-care sys­tem was dif­fer­ent: pa­tients who needed emer­gency care were sim­ply taken as quickly as pos­si­ble to med­i­cal care. Am­bu­lances weren’t crewed with pri­mary-care paramedics, let alone ad­vanced-care paramedics, whose job it is, of­ten, to sta­bi­lize pa­tients be­fore they even be­gin their trip to an emer­gency room.

All sorts of things have changed in med­i­cal care, from the size of equip­ment to the spe­cial­iza­tion of treat­ment to the sched­ul­ing of pro­ce­dures that are bet­ter done at larger, more cen­tral­ized hos­pi­tals.

If ev­ery sin­gle change or clo­sure is go­ing to be a bat­tle to the death, it’s easy to un­der­stand why provin­cial gov­ern­ments would be leery of do­ing any­thing. The prob­lem is that, for health care, the sta­tus quo can’t con­tinue. Not un­less, of course, we all agree to pay a sub­stan­tially larger amount of taxes to pay for it.

And I don’t see any­one putting up their hands to vol­un­teer for that.

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