doctors leaving Newfoundland
- 0Aug 1, '08 by GingerSueThese doctors are resigning and planning to leave Newfoundland (Canada) - this will mean that health services for women (with cancer) in Newfoundland will be reduced.
The doctors are explaining that they are not able to provide new treatment options for women with cervical cancer. As the article explains - the system has been offering to airlift women out of the province - but that is not considered to be an appropriate option for these women - because they will be separated from their support systems (when they are most vulnerable).
What will help?
- 0Aug 2, '08 by JolieCan one of our Canadian posters shed some light on this?
Do provinces fund and allocate healthcare differently, making quality and access different in different provinces?
Or is Newfoundland an area that is considered "less desirable" to work and live, meaning that fewer healthcare professionals are willing to practice there?
Why the disparity?
- 0Aug 2, '08 by Fiona59Newfoundland for as long as I can remember has been considered a "poor" province. So I really don't know how they are utilizing their transfer payments.
The population is small and spread out across a fair chunk of land. If you consider the population of this area, three specialists could be considered good.
It's always hit me as a place dominated by the RC church, so perhaps that could be part of the issue.
- 0Aug 2, '08 by NotReady4PrimeTime, RN Senior ModeratorIn Canada health care is a federally regulated but provincially managed responsibility. That means that each province decides where and how to spend their health care money. The money to fund health care comes from a combination of provincially collected tax dollars and federally collected and administered tax dollars in the form of transfer payments. The "have" provinces pay more into the federal coffers and the "have not" provinces receive more. The provinces then determine their own priorities for their residents and decide what they will pay for and what they won't. this has led to regionalization of many highly-specialized programs... it doesn't make fiscal sense to have MRI scanners in every hospital in a province, or a tranpslant program in every major city and so on. So indeed quality and access are not universal across the country. (The same can be said for the US, though.)
Each province for example has its own formulary of drugs: a list of drugs that the province will allow to be prescribed within its borders and which drugs the province will pay for through pharmacare programs and for inpatients. (Sounds kinda like an HMO, doesn't it?) A friend of mine is an oncologist who moved from one province to another for what he thought was a great opportunity only to find the province was dictating what treatments he could provide for his patients, based largely on cost. He left for one of the midwest states where he has happily been treating his patients for the last 15 years.
Newfoundland has historically been a have-not province, as Fiona59 mentioned. It's comprised of a large island that is almost entirely rock, with hundreds of fishing villages all along the coast, and a vast area of wilderness on the mainland with a few medium-sized but isolated towns and another hundred or so fishing villages along the coast. Newfoundland and Labrador joined Canada in 1949; before that it was a protectorate of the British Empire. Its economy was based on fishing and sealing until about 10 years ago when offshore oil drilling started bringing in pots of money. Around the same time the Atlantic fishery collapsed and threw thousands of people out of work; the protests against the seal hunt did almost as much damage to their economy. Where health care is concerned there are only a handful of hospitals in the province,with the tertiary care centres in St John's. The cost of living is fairly high because of the nature of the location and topography of the province and its cities and towns, but incomes tend to be lower than in most other provinces. Newfoundland is the largest exporter of labour in Canada.
Each province has its own problems within its health care system. Alberta is currently undergoing a huge and entirely whimsical overhaul, with no discernable plan and no identified goals. We have lost all four of our public health physicians for reasons that may never be truthfully explained. The health minister originally said that their salary demands (in this province of $multi-billion surpluses) were just too high. The doctors involved have withheld their explanations for contractual and ethical reasons. It's all a big mess. Staffing and recruitment are huge issues all across the country. Who knows where we'll all end up?
- 0Aug 2, '08 by NotReady4PrimeTime, RN Senior ModeratorI agree, but whose definition of "reasonable distance" will we use? Canada is the second largest country by landmass in the world, and we have a population very close to that of California. I don't consider a drive of 500 miles in day to visit my parents to be unreasonable, because distances in Canada are like that. (I just don't turn around and come back the same day... :chuckle ) Most provinces pay transportation costs for some diagnostics and out-of-area treatments. Then there's the definition of "clinically-indicated". Should I be given an MRI because I want one, or because I need one and it will have an influence on my treatment? Alberta now has two travelling MRIs that go to the patient instead of the other way around. But waiting lists are long, and who knows how many of those are "clinically indicated".
- 0Aug 3, '08 by JolieJan,
I understand your explanation of regionalization of care as being cost effective with patients traveling to specialty centers rather than every outlying hospital having every bit of technology available. (As a side note, that is how perinatal care was delivered here in the U.S. when I started in nursing over 20 years ago. Now, due to liability and patient-demanded convenience, almost every community hospital has a NICU with perinatologists, neonatologists, specialized staff, and lots of empty beds, making care horrendously expensive.)
But I don't understand your explanation of how care is allocated. Say for example, that I needed a transplant, but lived in a province that did not offer that service. Are you saying that the transplant could be denied due to priorities set by my province, or are you saying that it would be provided in another location? I guess my question is this: Might one be denied care based on the province in which she lives that another province would approve?
- 1Aug 3, '08 by Fiona59Transplant lists are lists, regional hospitals perform the surgeries. There are transplant co-ordinators scattered around the provinces who make the arrangements when and if your organ is available.
Care can be denied if the drugs are deemed experimental or prohibitively expensive. There was something in the media a while back about a drug that was experimental and some absurd figure (over $10K/dose comes to mind) and how the families benefits plan wouldn't cover it (employers add on insurance usually covers 80% of meds) and the family felt that the province should pick up the tab. I'm pretty sure the manufacturer donated it.
When care isn't available in one province, the patient is usually transferred to the nearest care centre in another province. Right now on my unit we have patients from Saskatchewan and BC because there isn't the type of care near them and it is actually closer to us than to transfer them to hospitals in the southern area of their home province. My hospital routinely handles all the high-risk and multiple births from most of the far north.
It sounds complicated to explain (especially to Americans) but it is actually very efficient.