Big­ger hospi­tals not the an­swer

The Chatham Daily News - - OPINION - DR. BARRY BRUCE

At what point do we stop call­ing them “mega-hospi­tals” and start call­ing them “giga-hospi­tals” (that is, over $1 bil­lion in costs)?

Hospi­tals alone con­sume about one-third of On­tario’s ap­prox­i­mately $61-bil­lion health care bud­get. If the prov­ince wants to save money and im­prove health ser­vices, start here.

For in­stance, the Ot­tawa Hospi­tal has pro­posed a dou­bling of the size of its ag­ing and over­flow­ing Civic site. To put this $2 bil­lion pro­posal into con­text, the en­tire an­nual bud­get of the Cham­plain LHIN is only about $2.5 bil­lion. Such an enor­mous project sounds ex­cit­ing. How­ever, once the rib­bon is cut, dou­ble “giga” an­nual op­er­at­ing costs will fol­low, a fis­cal tor­nado suck­ing up scarce lo­cal health care fund­ing.

Fur­ther­more, the clin­i­cal and sys­tem ra­tio­nale is un­clear.

True, the pop­u­la­tion is “ag­ing.” How­ever, this fact alone fails to con­sider that new el­ders are health­ier in im­por­tant ways than the heavy smok­ing gen­er­a­tion pre­ced­ing it. More long-term-care beds are be­ing built. Ever more “key­hole” sur­gi­cal pro­ce­dures are be­ing de­vel­oped. Hospi­tal in­ter­nal ef­fi­cien­cies need a lot of work and also in­crease ca­pac­ity.

How­ever, if the bath­tub is over­flow­ing now, it’s im­por­tant to “shut off the tap” as a first mea­sure. Badly needed ini­tia­tives to pre­vent hospi­tal ad­mis­sions and long stays are un­fo­cused, grossly un­der­funded, and lie out­side the man­date and com­pe­tence of the hospi­tal sec­tor it­self.

As im­por­tant as hospi­tals are, we should not want to be pa­tients. When­ever pos­si­ble, we should want, first, to pre­vent ill­ness, or, fail­ing that, to be man­aged well at or close to home.

Health fund­ing pri­or­i­ties should re­flect this uni­ver­sal de­sire to avoid hos­pi­tal­iza­tion. Pre­ven­tive and com­mu­nity care fund­ing need to be the foun­da­tion of a ra­tio­nal sys­tem, not just an af­ter­thought. For ex­am­ple, there are in­ter­ven­tions that could well re­duce the nearly 8,000 bed days used by re­tire­ment home res­i­dents in a sin­gle lo­cal com­mu­nity hospi­tal by 50 to 90 per cent. More team-based fam­ily medicine is needed, with fund­ing tied to avail­abil­ity, qual­ity of preven­tion and treat­ment, and abil­ity to avoid un­nec­es­sary hos­pi­tal­iza­tions.

Pub­lic Health could play an im­por­tant role. Home and com­mu­nity care could be cen­tred on the needs of the whole pa­tient, not re­stricted to a sin­gle task. The failed “Health Links” ap­proach to the five per cent of pa­tients caus­ing 65 per cent of health care costs needs to be re­strate­gized and im­ple­mented by clin­i­cal and epi­demi­o­log­i­cal pro­fes­sion­als rather than bu­reau­crats. Other ap­proaches re­main to be dis­cov­ered.

Let’s avoid the mis­take of dou­bling a bloated and dys­func­tional hospi­tal sys­tem. Dr. Barry Bruce is a fam­ily physi­cian in Eastern On­tario in an award-win­ning fam­ily health team, former chief of staff in a large ur­ban hospi­tal and has pro­vided re­tire­ment home care for years. He is re­cip­i­ent of the OMA “Physi­cians Care” award, “Fam­ily Physi­cian of the Year” for On­tario, and the Or­der of Ot­tawa. Twit­ter: 1Team4Health

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