Patient-Focused Funding The Way To Go

The BC government recently announced that it was moving towards patient-focused funding for the province's hospitals. This enlightened move is exactly the kind of thinking the province's health care system needs and is what Minister Kevin Falcon was brought in to do. Our health care system is largely unsustainable with long wait times, rationing of care and a $15 billion dollar price tag that takes up 40% of the budget. With the current block funding model, hospitals get given their budgets ahead of time and each surgery and stitch comes out of that money. With this system, there is no incentive for being efficient. In fact, this funding model creates an incentive to perform fewer and fewer procedures as to not blow through your yearly budget, creating a bizarre scenario where hospitals LOSE money for doing procedures. The patient-focused model announced by the government institutes some funding that follows the patient--it goes to whichever hospital performs the needed procedure. Thus, hospitals MAKE money when they perform more procedures. This injects a much-needed element of competition to the health care system and like most everywhere else the free market is unleashed, choice goes up and price comes down. With the new funding model, hospitals get rewarded with incentives and funding for excellence. For example, if a hospital's maternity ward is exceptional and attracts patients from far and wide, it will get rewarded for that. Unfortunately, the provincial NDP is opposing this new funding model, opting to sound the tired call for more spending and "innovation." One of these demands is unsustainable, the other an empty, meaningless buzz word used by politicians that are out of real ideas. This government plan is a much needed reform, one of several that we need, and will bring down costs, shorten wait lists and improve patient care

Preventative Treatment Not Always a Wise Investment

I often hear proponents of increasing health care spending arguing for more preventative care. "More diabetes tests, mammograms, PSA tests, gene testing, blood work ups" they demand. More power to them. Mammograms save lives. PSA tests can find prostate cancers early when survival rates are north of 90%. I like preventative treatments. However, those calling for them often parrot the same refrain: prevention saves the health care system money. This statement seems logical, it seems reasonable. It is also, unfortunately, not true. In many cases, preventative care ends up costing the health care system more than the illnesses they prevent would have cost. I dug up an old Charles Krauthammer article that I read a while back, and he explained it well: "Think of it this way. Assume that a screening test for disease X costs $500 and finding it early averts $10,000 of costly treatment at a later stage. Are you saving money? Well, if one in 10 of those who are screened tests positive, society is saving $5,000. But if only one in 100 would get that disease, society is shelling out $40,000 more than it would without the preventive care." Since you have to provide preventative care to everyone, even those who may have never gotten the disease in the end anyways, the preventative care will often drain more out of tight health care budgets than it saves. Why am I writing about this now? Last week, the Cancer Advocacy Coalition of Canada released a report calling for many health care innovations, including cutting-edge genetic testing for cancer. These gene tests, or 21-gene assays, can determine whether particular breast cancers will benefit from radiation treatment. Apparently, roughly 25% of breast cancers will not respond positively to radiation treatment, meaning it is essentially useless. Interesting stuff. The group goes on to argue, and the media reports, that Canada should have more access to these $4000 tests. By telling us which 1 out of every 4 breast cancers won't benefit from the $15,000 radiation treatment, these tests will save the health care system money. Got that? If we test all breast cancers at $4000 a pop, we will find out which 1 out of every 4can forgo the expensive $15,000 radiation treatment, thus savings our health care system a bundle. Let's run that math down one more time:
$4000 tests x 4 = $16,000
1 x $15,000 radiation treatment avoided for every 4 tests = $15,000
In the end, doesn't this particular preventative procedure actually cost the health care system $1000 more for every 4 breast cancers?
Now, albeit, this is a rather cold method of determining appropriate care. You could argue, and I would strongly agree, that the $1000 is money well spent for sparing women the agony of radiation treatment that's not going to do any good. Any innovation that can help in the fight against cancer is a welcome one, even if it costs more. However, I'd just rather here our leaders simply say that, instead of masquerading behind disingenuous arguments about "savings."