Markham Stouffville Hospital Case Summary
Heather Morrow
Health Science 472a
Sept. 26 / 01
EXECUTIVE SUMMARY:
The state of the Health Care system is a topic of increasing concern. Like many other hospitals in Ontario, the Markham Stouffville Hospital is faced with a growing population that is increasingly diverse. The people who use Markham Stouffville Hospital tend to be affluent, educated, and younger in age. However, despite a multiplying population, the hospital has had to decrease the number of beds available and alter how Health Care services are provided. For instance there are more outpatients after surgeries. At the same time, hospital staff has been expected to maintain the same level of quality care. There has also been a tremendous increase in the number of emergency visits, ambulance use, admissions to the hospital and more surgeries. The increases in service use is placing a huge financial strain on Health Care. The cost of the Ontario Health Care program is the result of many different problems. The system used in Ontario hospitals like Markham Stouffville is being faced with increasing costs and inefficient management of finances. However, there are several solutions to the financial troubles. For example, the Markham Stouffville Hospital tired to implement a Integrated Health System to Change how finances are handled. I suggest increasing the amount of health promotion programs available in the Health Care system over the next two years.
PROBLEM:
There are a multitude of problems that the Health Care systems faces. Cost is a problem that must be addressed as it affects all parts of delivering health services and even the very future of Health Care. If how funds are spent is not changed then Health Care as we know it will become severely crippled. The causes of the financial troubles are many, however, there are several which stand out. The first cause is that the federal government is decreasing the amount of funds they provide the provinces for Health Care. The provincial government must then decide how to allocate less money among an increasing number of competitive service sectors with an increasing number of patients. Another and very important cause of Health Care problems is the way physicians are reimbursed for their services. Doctors obviously do very important work, but the fee-for-service method of payment is out dated and too costly to continue. Physicians are paid based on each visit a patient makes no matter how long it lasts. The patient may then have to go on to see a specialist, which increases the cost of the patient’s treatment. With a large lack of coordination in the Health Care industry, services may be duplicated (such as X-rays) resulting in massive inefficiency and more spending than is necessary. One last cause of the increasing costs of health services is that the current system is still thought of as a cure for illness. The result is increased use of costly procedures and medications. Physicians do not encourage people to prevent illness, therefore avoiding procedures which use decreasing Health Care funds.
CRITERIA:
With the problem of cost established solutions must be found. Standards must be set to measure possible solutions against as not all will work. The first criteria is that any alternative must not violate the five Medicare principles (Public administration, comprehensiveness, universality, accessibility, and portability). The principles of Medicare exist so people are able to receive the Health Care they need without worry. The second criteria to evaluate the alternatives is that the efficiency of Health Care delivery will be improved. In the long run, improving efficiency will save money in many areas where there is duplication of services. Another criterion to use would be to avoid layoffs as much as possible. Decreasing the number of employees would save money, but would increase the workload of a work force already under strain. The fourth, and a very important criteria, is to ensure the quality of Health Care is maintained. If the quality of care is adversely affected by any possible changes then that alternative should be rejected. People have a high expectation of the services they receive at hospitals like Markham Stouffville.
ALTERNATIVES:
There are several possible alternatives to be considered. The first is to reform the way doctors are paid. Creating a method of payment based on salary would be most beneficial. The salary each physician should earn would be founded on years of experience, the number of patients the physician is responsible for, and if the doctor has specialized in any one field. The salary system would not violate any of the principles of Medicare. Doctors are paid by the government so public administration is not affected, neither is the principle of comprehensiveness, universality or portability. Changing the way doctors are paid would not cause layoffs, in fact it could potentially make funds available to hire more doctors or nurses for hospitals like Markham Stouffville. Efficiency of Health Care would be improved as it frees up precious funds which could be diverted to needy areas of health services delivery. One major disadvantage of using a salary based system of payment is that physicians would be very resistant to change. They have no reason to agree to being paid a salary as the fee-for-service method provides them with a very lucrative income. The next alternative is to create a committee which reevaluates how funds are distributed throughout the Health Care system. The committee would look for areas of possible waste, how to eliminate duplication of services, if administration should be rearranged in hospitals, et cetera. The Health Services Restructuring Commission has obviously not been effective and too time consuming. Altering how decreasing funds are allocated has several advantages. Efficiency of the services would be improved by preventing waste of funds and other resources. Quality would not be affected if only wastefully practices were abolished and all others maintained. However, if this solution was used it could possibly result in layoffs, which is not desirable at all. It could also result in compromising accessibility to the comprehensiveness of health care, maybe even accessibility, if there were services eliminated for being wasteful. One last alternative is to focus on moving the Health Care system in the direction of preventative medicine, or health promotion. Physicians need to be taught to help their patients lead healthier lifestyles, and promote health rather than using the Health Care system as a cure for illness. The advantages of this alternative are far reaching and long term. Money would be saved in the long run as people would not need to use as many health services. Health promotion programs would not result in layoffs as preventing illness would only relieve some of the pressure on an overburdened work force. The only possible principle of Medicare that would be affect is accessibility. People living in more remote regions may not have access to health promotion programs, though they already do not have accessibility to all health services people in largely populated regions do. The efficiency and quality of care could only be improved as more funds are available and preventable illnesses, such as diabetes, are decreased. One other disadvantage is that the many different areas in the province will not need the same type of health promotion programs. Each area is unique and any programs developed will need to consider the originality of each community.
ACTION PLAN:
Of the alternatives presented, I would recommend implementing the third alternative of increasing the amount of health promotion. The implementation of such programs should occur over two years. For communities such as Markham Stouffville it offers great opportunity to create diverse and innovative programs. I suggest that there are three stages to creating a large health promotion component in the Health Care system. The first stage would be for the hospitals and their community boards to study the what type of health promotion programs would be most beneficial to their area. Money will be saved by not developing a program in a community that does not need it. While decisions are being made about what programs should be put in each community, the programs can be developed and goals set. The first stage should take approximately five to six months. The second stage should be to run the programs developed on a small scale for six months. At the end of the six months an evaluation should be run. Although this will not give definite conclusions for long term results, it should give general ideas and trends for the success of the program. If any problems are observed changes can be made to correct the problem. The last stage is to open the health promotion programs to the whole community and surrounding areas. When the programs have run for a year, it would be beneficial for the hospital to reevaluate their programs to ensure it continues to work smoothly, still meets the needs of the population, and a decrease in the use of Health Care services occurs, therefore, resulting in an increase in savings.
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