Wednesday, July 29, 2009

Truth, like rain, does not care who gets wet

Okay, I'm feeling grumpy today. And my mood didn't improve when, against my better judgement, I opened a "this-is-for-real" chain e-mail and found this:

The actress Natasha Richardson died after falling while skiing in Canada. It took eight hours to drive her to a hospital. If Canada had our healthcare she might be alive today. In the United States, we have medical evacuation helicopters that would have gotten her to the hospital in 30 minutes.
We're fortunate to live in the United States where we're free to form and express opinions. Like whether the healthcare reform measures on the table are, indeed, the right way to go. I'm still working on an opinion, learning more about what's in the package and how it will effect dimensions of care that are important to me. Like, will the changes make healthcare safer? More effective? Timely? Efficient? Patient-centered? Equitable?

It's no secret that I've been dissatisfied, personally and professionally, with the bang we get for the buck under the highly fragmented and hard-to-access system we currently have.

And, no, I'm not going to Canada.

But I do know a thing or two about Canada, being married to an ex-pat Canadian for a quarter-century and all that comes with that.

Canada is relatively easy to find on comparative health outcome rosters (they're usually a goodly number of notches ahead of the U.S. in measures of population health like infant mortality rates and life expectancy). Oh, and Canadians do pretty well in dollars spent, too (in 2005, using 9.9% of their GDP on healthcare relative to the U.S.'s 15.3%).

All citizens in Canada recently got free online access to the Cochrane Library, where credible studies are synthesized and results shared (using both highly technical language that appeals to researchers and with words that make it easy for consumers to understand complex topics). So Canadians understand concepts like "due date" and "hospice care" which is why, perhaps, they spend less money fixing what ain't broke and trying to fix things that can't be fixed. Don't know for sure, just a guess.

Empowering citizens by ensuring they have access to high-end, evidence-based medical information is not particularly sexy or glamorous (especially when compared to the health education we enjoy in the U.S. where advertisements portray middle aged men who can't pee as the next generation of Outward Bound campers).

One pay-off is that with credible information, Canadians--and others who use facts to inform their decisions--increase their ability to make satisfying, even life-preserving, decisions. It's helpful to know, for example, that more than 10% of the U.S. air ambulance helicopter fleet crashed between 1995 and 2000. And that the safety of air evacs, to this day, is below--far, far below--what passengers on craft subject to FAA oversight enjoy.

Because it's big, fast, and glamorous doesn't make it necessary. And making it subject to regulatory oversight doesn't have to diminish its safety or effectiveness. Outcome data are helpful to know, should you have to weigh the risks and benefits of air transport--and other high tech gadgetry--to facilitate the care of someone in your family.

Frankly, just knowing that Canadians have helicopters might be a step in the right direction.


PurpleRN said...


Anonymous said...

I want to add my two cents to the healthcare debate. I only have opinions, not beliefs or convictions on healthcare. I keep thinking about the cause of high costs and what would bring them down. It seems to me that in order to get more people willing to participate in the risk pools of existing health insurance companies it would be very helpful to inject a cost cutting mechanism into the equation. It seems counter intuitive that putting a government run system rather than a government mandated system will drive costs down for the consumer. By government mandated I mean a system that forces existing insurance companies to be less bureaucratic, and unable to reject claims that a medical person inputs. In addition the government should force the insurance industry to allow many more competitors to enter the insurance market more rapidly as a way to drive costs to the consumer down. I use the analogy of the long distance companies that drove telephone costs down all through the last 20 years of the last century. It used to be outrageous to call from one state to another when only Ma Bell was the only player in the domestic telepohone market. They fought tooth and nail to keep MCI and Sprint from entering the market but when they did costs to the consumer started to come down. Today most long distance to a consumer who researches a bit is free. Why can't congress follow a similar template with health insurance? I fear that we will eventually have a Ma Bell of health insurance in the federal government and costs will go even higher with all kinds of rationing of products and services.And in a collectivized system there are always powerful czars who take over and run things on their whims. I think that it may be better to fix the existing insurance industry with tough new laws rather than inject the federal government into the equation as a market (monopoly?) player.

Anonymous said...

Well, all i can say is: here is another Stupid American who thinks that the USA is the center of the world. What you wrote about Canada is EXACTLY why other countries HATE YOU!! Don't come then! WE don't want you to Poison us!!

Anonymous said...

Dear Anonymous: Barbara Olson did not make the comment to which you bristle (with Canadian nationalism.) She was only quoting an e-mail to which she is probably at odds with almost as much as you. America has long waits for helicopters too. We just had a helicopter crash here in New Mexico. Eastern Canada has some of the best commercial pilots in the world by the way. But you were too hateful and too quick with your response.

Barbara Olson, MS, RN, FISMP said...
This comment has been removed by the author.
Barbara Olson, MS, RN, FISMP said...

Thanks, Tom. Every group has its outliers. I'm guessing that in this case the password to Cochrane Database got lost.....

AWM RN said...

I understand that in Ontario, Canada medical helicopter pilots are centrally coordinated and dispatched (and government funded). The pilot of the helicopter is not informed who their passenger is (e.g little Johnny who needs an operation stat or he won't make it). The pilot makes the decision on flight safety based on weather and flying conditions alone. This is not the case in the U.S. Ontario has a very low medical helicopter crash rate.

Anonymous said...

To AWM RN I thank you for your informative insight into Canadian helicopter pilots. I am sure they do a great job.

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