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Misuse of Funds

Healthcare is a huge chunk of our budget, and politicians have a responsibility to spend that wisely. In fact, the opposite is happening. Why? It's a mixture of ideology (control/power) combined with sheer ignorance by decision makers of how healthcare operates. The existing money that could be used to deliver effective care is being squandered.

Fee for Visit

The BC government likes to attack fee for service (FFS) as outdated and broken. For family doctors, it is. But it's not FFS as a model, but it's implementation. Most specialists are paid FFS and it seems to work there? What's the difference? Specialists are paid fees to provide services — something valuable. That's in fact the whole idea of FFS: pay someone to provide something we need and value. Like when we pay for a plumber to fix something.

In BC, family doctors aren't paid to provide a service, they're paid per visit. It doesn't matter what happens in that visit. Renew a prescription, exam and diagnosis, treatment plan and education, manage a chronic illness. All are distinct services, with distinct value. Yet doctors bill for the exact same fee. They're being paid for the visit, not the service. So of course, the incentive is to make each visit as short as possible. Which results in providing less value.

That's completely contrary to how fee for service is supposed to work! It defeats the purpose.

Why? Because healthcare leadership and politicians don't understand how healthcare actually operates. They see a patient having an appointment with a doctor, but can't differentiate between services. One service helps the patient. Another keeps them sick, and ends up with them seeing another doctor down the road, maybe landing in the ER. One provides high value, the other doesn't. If you can't see the difference, you've got a problem.

A fee for service implementation that doesn't value services is a failure.

Valuing what's visible

If you don't understand and see the real work, you focus on what you do see and understand. That's shiny buildings. That's lots of bodies, no matter what they're doing. They become a proxy for actual value. But not a very good one.

A large part of the reason we have UPCC's and such has to do with control and power, as I've discussed at length before. But it's also a failure to understand healthcare, and therefore substituting things that are more easily understood (facilities and headcount).

It's like the clueless manager walking around an office, seeing butts in chairs, and being happy that everyone is doing work, even if they're all sitting around playing video games or working on their resumes. Clueless!

And don't even get me started on the massive growth of healthcare administration which doesn't improve patient care...!

Valuing Time

If you don't understand the actual services provided by highly skilled professions, a reasonable fallback is to trust them, and just pay them for their time and assume they'll do the right thing.

This is actually a good fallback. And a definite benefit of the contracts that are so favoured over fee for service by government. That part's not a bad thing.

But then they go muck it up and put all kinds of other restrictions. Requiring physicians to adopt work practices and models of care that doctors know are bad for patients, and bad for doctors. Increasing risk and bad outcomes. Worsening consequences for the overall system rather than improving them. And then putting gag orders on top of the whole thing.

The whole idea of valuing time is to trust skilled professionals when you really don't understand what they're doing. To then have someone who doesn't know what they're doing tell them what to do completely defeats the purpose.

As mentioned, there's other reasons they're doing this, related to autonomy, control, and so on. But at the core, it's undermining the value of skilled professionals rather than recognizing it.

Now They Want More Money?

When the Premiers meet with the Prime Minister in Victoria on July 11-12, more healthcare transfers from the federal government to the provinces is top of the agenda.

Without understanding anything about actual healthcare delivery and value, what do you think BC would do with any new money?

It would throw away even more to pursue it's idealogical healthcare fantasy and further accelerate the destruction of our entire healthcare system.

If the money already in the system — let alone more money — were spent on proven, effective models of delivering healthcare instead, we could bring back the doctors we've driven away from family practice.

They could provide the actual care that British Columbians need to keep them — and our healthcare system — healthy.

Please, don't let the government throw away any more money on bad healthcare.

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