On incomplete care

Shorter Dustin Duncan:

I'm pretty sure a health care system can't do more than two things at a time. And for the ministry I'm overseeing, surgery is no longer one of them.

On unreasonable explanations

Bloggers and columnists alike have had plenty to say about the Sask Party's negotiations toward a surgical tourism program sending Saskatchewan patients to B.C. But there are a couple of points which seem worth following up on based on Murray Mandryk's column in particular:

Lingenfelter noted one redacted page that he suggested was blacked out because it clearly showed the government was contemplating paying those premiums. McMorris and government officials insisted Monday that premiums weren't even mentioned in the blacked-out copy.

As per usual, the truth lies somewhere in the middle.

A copy of the redacted words later obtained by StarPhoenix reporter James Wood didn't mention the word "premiums", but did show the B.C. government was requesting a fee for "administrative and capital overhead".

The first point is a relatively minor one. But it seems rather striking that documentation which was supposedly too confidential to be released in response an access to information request on January 5 suddenly became available to only selected media within a week. And I'd imagine the issue is one worth pressing if there's any more followup on the access request.

More substantively, though, I have to wonder whether Mandryk is right to let the Sask Party off the hook for its seriousness about the plan to send patients to B.C.:

Deputy health minister Dan Florizone was quick to explain Monday that this fee differed from a premium and -- more significantly -- it was B.C.'s proposal and not something that Saskatchewan was seriously considering.

Florizone's latter explanation appears a reasonable one, given that the Saskatchewan government doesn't ever seem to respond to B.C.'s plan.

Let's leave aside the fact that the discussion originated between the respective premiers who presumably wouldn't have been making idle chitchat, and focus instead on how the Sask Party responded internally. On multiple occasions, Ministry of Health officials told their B.C. counterparts that the issue was going to be presented to Saskatchewan's Treasury Board - first in September 2009 (a meeting that was cancelled for unspecified reasons), then in October.

Now, it's not clear why the meetings didn't take place. And if the Treasury Board step is a smaller one than it sounds like to me, then I'd be interested to hear that. But it would seem to me that a proposal wouldn't be lightly put in front of the Treasury Board - and that the purpose for taking it to that level would be in part to find budget room for a project which was at least under serious consideration in principle.

Which means that while at least this time the Sask Party didn't get to the stage of actually making final decisions before foisting a policy on the province, it seems hard to justify the conclusion that the proposal wasn't taken seriously on Saskatchewan's end - and downright impossible to defend Don McMorris' denials last fall.

SUUUUUUUUUUUUUUURGE!!!!

Make no mistake, the Wall government is planning a "Mission Accomplished" banner as we speak (whose unveiling will of course bear no relation to any actual progress). But can even the Sask Party find an excuse to put its leader in a flightsuit?

Hurry up and wait

The CP reports that not only have the Cons failed to address actual health wait times, but their negligence in dealing with the provinces has ensured that we still don't even have useful data to compare provincial wait times and outcomes:

Ottawa set up a $5.5-billion Wait Times Reduction Fund in 2004 as part of a 10-year plan to strengthen health care, and in return each jurisdiction agreed to establish comparable indicators of access to health care professionals, diagnostic and treatment procedures.

The idea was to provide the public with a national picture in which provincial laggards and leaders could be readily identified by their citizens. But it never happened, says (a Health Council of Canada report).

"The information needed to paint a cross-Canada picture - information that allows Canadians to see changes over time and to compare wait times data from different parts of the country - is not available from all jurisdictions, despite widespread recognition that it should be."

Provinces were supposed to establish pan-Canadian benchmarks for five priority areas of health care by Dec. 31, 2005, but they have not done so, says the report. Instead, each province has declared benchmarks for different procedures.

"Without comparable data - information that is based on similar ways of measuring change - it is not possible to determine on a national level whether meaningful reductions in wait times have been achieved, or how many people receive their care within the time frames (benchmarks) agreed to," says the report.

The Health Council of Canada rightly notes the problems with an overly narrow focus on wait times to begin with. But whether or not it makes sense to divert health resources to a small and arbitrary list of procedures, it could only be a plus to have an accurate reading on how long patients actually have to wait in as many areas as possible.

Unfortunately, thanks to the Cons' accountability-free philosophy in dealing with the provinces, there's little prospect that the situation will improve as long as Harper holds power. And Canadians already waiting for health care surely can't be happy having to wait for a change in government before they'll have any idea where they stand.

Nicely done

It takes some effort to come up with a suitable amount of derision for PMS' announcement that the Cons have kept their wait-times promise through their laughable budget announcement and subsequent one-procedure agreements. So kudos to Scott Feschuk for doing the job.

Right here waiting

In case there weren't enough reasons to doubt the effectiveness of the Cons' wait-times funding, the CP reports that Saskatchewan's share of it will demonstrably do nothing to reduce the wait times which the Cons are supposedly trying to target. Instead, the allocation will be based on goals which the province was going to meet anyway:

The Saskatchewan government has become the latest province to sign up for the federal government's health wait-time guarantees, taking in nearly $25 million in exchange for putting a cap on the length of time a patient waits for heart surgery.

By 2010, a Saskatchewan resident needing a coronary artery bypass graft will wait no longer than 26 weeks under the new guarantee announced Thursday. The province is already very close to meeting that target, meaning most of the money will go to the bottom line of the health-care system...

Saskatchewan Health Minister Len Taylor said the province chose the area of cardiac bypass because it is already doing quite well at meeting national wait-time benchmarks.

"We have chosen an area that we know we can be successful," Taylor said. "We've built capacity to this point."

There are three levels of urgency when it comes to coronary artery bypass.

Under the new guarantees, Level 1 patients will get the procedure within two weeks, Level 2 within six weeks and Level 3 within 26 weeks.

Right now, according to provincial health officials, almost every Level 1 and Level 2 patient and about 98 per cent of Level 3 patients get the care they need in that time frame.

Contrary to the whining of the Sask Party, it's entirely understandable why the province would want to make sure its funding is based on targets which the system was set to reach rather that otherwise distorting the system. And indeed it's probably the ideal result for the Cons' funding to go into the health care system generally rather than being singularly targeted toward a narrow range of procedures (or worse yet a single one).

But that only serves to highlight the pointless of the Cons' plan to begin with. And if the best one can say for the Cons is that their policy may accidentally have some positive effects by failing to meet its own goals, that surely speaks volumes about just how ill-advised the plan was to begin with.

Hurry up and wait

The CP reports that the Cons' wait-times plan is only getting more and more laughable as time goes on. This time, the comical element is Tony Clement's first announcement of a provincial agreement...which provides cash to Nova Scotia now in exchange for results no earlier than 2010.

Again, it's probably for the best that the Cons aren't getting further now given how damaging a wait-times guarantee may be in the wider scheme of things. But if anybody was still clinging to the illusion that the Cons' wait-times spending (or most other parts of their budget) bore any relation to benefits in the real world, the delay in any measured results only confirms beyond doubt that they're more interested in prominently announcing the funding than seeing whether it does any good.

The reality gap: wait-times edition

The CP follows up on the question of how provinces will respond to the Cons' wait-times funding. And as I'd suspected, the uptake looks to be almost entirely focused on a single area per province rather than any commitment to meet all five of the Cons' targets:

Health Minister Tony Clement says he is close to announcing agreements with most provinces for medical wait-time guarantees...

But the agreements will cover only one area of treatment per province, far short of what was promised in the 2006 election platform...

The 2006 Tory election platform committed the government to “ensure that all Canadians receive essential medical treatment within clinically acceptable waiting times,” suggesting that all essential care would be covered.

The platform identified five priority areas as a starting point: “cancer, heart, diagnostic imaging, joint replacements and sight restoration.”

But Clement conceded that the agreements will be more limited in scope. The priority list is also now open to provincial discretion.

“What we’re asking, for the purposes of this agreement, is for a province or territory to choose one guarantee they would declare in place and operational within the next three years.”

If there's any consolation in this news, it's in the fact that the wait-times concept is itself a flawed one. So at the very least, the provinces' apparent rejection of the Cons' across-the-board standards should have little negative impact on the care received by Canadian patients - and may only ensure that provinces continue to deal with a more complete view of health-care priorities rather than focusing only on the Cons' target areas. (In other words, this is likely another promise better left broken.)

But at the same time, the Cons have been awfully eager to highlight a pool of money that they apparently don't expect provinces to touch. And that massive gap between funding announced and funding actually likely to be provided shows that it isn't just in the area of tax credits that the Cons are actively exaggerating their social investment by taking credit for the potential maximum, while counting on limited uptake to minimize the amount spent and accomplished.

Which makes for yet another area where the Cons' rhetoric bears a tenuous (and shrinking) relation to reality. And their continued eagerness to keep widening that gap in turn offers one more strong reason why they simply can't be trusted.

Still waiting

It's no secret that many of the elements included in the Cons' budget had already been announced prominently, while some (particularly the fiscal imbalance plan) were important enough to stand out in even in the midst of a budget. But it's worth noting that what appears to be the Cons' entire solution to a main priority on coming to power was slipped in as an extra - and that there doesn't appear to be much reason for many (or perhaps any) provinces to take the Cons up on the bulk of their wait-times funding offer:

(R)eluctant provinces have been given more than $600-million to comply, even in a small way, with federal demands that they guarantee that certain medical treatments will be provided within clinically acceptable amounts of time.

Any province that limits waiting times for at least one procedure selected from five priority areas -- cancer care, heart care, cataract surgery, joint replacement and diagnostic imaging -- will share in a one-time pot of $61-million.

The funding amounts to something of an about-face for the Conservatives, who have said repeatedly they will provide no additional money for the guarantees -- requirements that the provinces pay to send patients elsewhere when treatment is not available locally in a timely manner.

At least $10-million will go to each province that falls in step with the Conservative plans, and another $500-million will be divided among those same provinces on a per capita basis. The three northern territories will share the remaining $12-million provided.

The funds can be spent any way the province or territory chooses. For Ontario, the decision to sign on to the federal demand for guarantees will mean an additional $205.5-million this year. For Quebec, it will mean $125.6-million. And even tiny Prince Edward Island stands to gain $12.1-million.

Now, it's a small plus that the Cons are at least now willing to offer some funding rather than trying to impose their promise on the provinces without offering any support. But while the Globe's coverage seems awfully sure that all provinces will sign on to the plan, such an outcome seems far from certain.

Let's note first the goofy structure of the funding. By setting up a fixed pool of funding to be distributed on a per-capita basis only among the provinces who participate, the Cons have ensured that each province which signs on will decrease the possible funding available for other provinces.

That may make for some interesting prisoner's dilemma-type situations among the provinces. But it surely isn't the most effective way to get as many provinces as possible onside. And it doesn't seem the least bit unlikely that once one of the largest provinces decides to put itself at the Cons' mercy in dictating its wait times, the others (along with most smaller provinces) will conclude that the diminished potential return isn't worth the cost of implementing the Cons' proposed guarantee.

But then, it could be that no province will see it as worth its while to sign on - particularly given the danger than any commitment will prove to be entirely one-sided.

After all, there's still the strong possibility of an election taking place before the budget passes: a province could easily commit to wait times targets this month, then see the government fall (or engineer its own demise) in April before the budget has moved through Parliament. Which would leave any province agreeing to the Cons' terms with no guarantee of receiving any funding at all...while a public promise would presumably be rather difficult for any province to backtrack from.

Of course, the Cons could have avoided this difficulty by setting a more reasonable deadline than the end of this month. And there's no apparent reason why such a later deadline wouldn't have worked for either side.

As for the smaller envelope of funding for meeting one priority, that'll likely be seen as more reasonable for more provinces based on the relative costs and benefits involved. But at that same time, it's also likely to ensure that each province focuses on meeting only the cheapest of its "guarantees".

And of course all of the above leaves aside the serious problems with a limited wait times program in general.

Notwithstanding the problems with their plan, the Cons will presumably claim that their limited offering completes their list of five initial priorities. But nobody should be surprised if many or all provinces indicate in short order that the Cons' idea of sufficient (and sufficiently-assured) funding is far from enough. Which would properly place the wait-times guarantee alongside the commitments to accountability and child care as areas where the Cons have gone through the motions without ultimately getting much done.