Conquering spiralling wait times
while working within the Canada Health Act can sometimes
feel like an impossible task. On the other side of the
Atlantic the British have come up with a third way between
public and private that might just work for us.
In April 2002, the UK introduced
streamlined Treatment Centres which they hoped would
reduce wait times for the same high-demand elective
surgeries, like orthopedic and ophthalmo-logical, posing
such problems here in Canada. With 29 of a planned 111
centres now functioning, over 110,000 Britons have been
treated in the centres, reducing the National Health
Service (NHS) waiting list for elective surgeries by
144,000 names, according to a report published by the
Department of Health in January.
So where did Britain's cash-strapped
healthcare system get the money? With a little help
from its friends in the private sector.
The NHS provided £350 million
($800 million) to develop the first centres, but an
investment of £2.3 billion ($5.3 million) over
five years is also expected from the private sector.
Private companies will develop and run 31 facilities
and contract their services out to the NHS at public
expense.
VALUE
ADDED
A number of studies have shown that specialized clinics,
such as cataract or hernia clinics, can operate at higher
capacity and with greater efficiency than generalist
facilities. The British system has taken this idea and
run with it.
"The main aims of the program are
to increase clinical capacity, improve access to elective
care and introduce choice and innovation to service
delivery," explains Claire Northridge, policy manager
of the Short Stay Elective Care Team. One example is
a private sector centre idea to launch two mobile units
offering ophthalmology services last February. By December
they had treated over 10,000 NHS patients.
Ms Northridge says a lot of work
went into drawing up fair contracts with private sector
treatment centre developers. One particular sticking
point was the fear that the private clinics would pilfer
NHS staff. The NHS-run centres are allowed to 'second'
staff from other areas of the NHS, but part of the appeal
of the private sector providers is their ability to
fill their ranks with additional — often foreign
— staff.
COULD
IT FLY HERE?
The idea of efficient, specialized care centres is not
entirely unknown to Canadian healthcare; it just doesn't
happen within the public system. The Shouldice Hospital
in Thornhill, ON, has specialized in abdominal wall
hernia repair for over 55 years and performs over 7,000
operations each year with remarkably high success rates.
Shouldice is one of just two private hospitals in Ontario,
the other being the Don Mills Surgical Centre in Toronto,
providing orthopedic, plastic and ophthalmologic surgery
to mostly publicly insured patients. Both pre-date the
Ontario law forbidding private clinics.
Dr William Orovan of Allegro Health
(the company that owns the Don Mills Centre), thinks
the UK treatment centres could solve Canada's waiting
list woes. He doesn't think we have the public funds
to finance such units, but does see an increasing drive
towards public hospitals contracting services from private
centres.
When Vancouver's St Paul's Hospital
was faced with the departure of 12 specialty nurses
last November, forcing it to temporarily close three
operating rooms, it contracted out 1,000 elective day
surgeries to the private Cambie, False Creek and Ambulatory
Surgical Centres. Doctors from St Paul's Hospital are
paid by the province, while the surgical centres provide
the operating rooms and support staff. St Paul's communications
director says they expect this arrangement to continue
until March.
The Vancouver Island Health
Authority is pursuing more permanent relationships with
local private clinics as it seeks bids for cataract
surgeries, bladder procedures, joint operations and
hernia repairs.
|
