Panaceia or Hygeia

immunize yourself against the pandemic of lifestyle diseases

Posts Tagged ‘hospital’

“Health” spending in Canada hits $172-billion, outpacing inflation

Posted by Colin Rose on November 14, 2008

Drugs now cost more than doctors and the cost is rising faster than inflation. Sooner or later this insanity has to end. Probably sooner. With a likely world-wide depression in the next few years there will be awakening awareness that most of those expensive branded drugs, such as Lipitor and Crestor, are for lifestyle diseases, like Type 2 diabetes, hypertension and atherosclerosis, related to junk food addiction which can be prevented and treated without drugs. But we need to take a $few billion of that $172 billion and put it into addiction research. Addictions of many kinds are at the root of most of the problems of developed capitalist democracies.

Note that Japan which spends per capita on its “health care” system only 38% of the USA and 70% of Canada has a longer life expectancy than either. Ergo, there is no relation between money spent on hospitals, drugs and doctors and life expectancy; if any, there is an inverse correlation. While everyone uses the term “health care” for the activities and effects of hospitals, drugs and doctors, these are really disease care. Some diseases can be cured but most can’t and in a high tech, fee-for-service medical system with an incentive only to do more, more people will be killed by the technology than saved by it.

Jeffrey Simpson in the Globe and Mail suggests as a solution to exponentially increasing costs more private “health” care. That will only increase the total cost as people with just spend more to support their addictions. Doctors in a fee-for-service regime will be only to happy to oblige. The only long-term solution I can see is to put all doctors on a salary. In such a system the driving incentive is to keep people healthy so doctors have less work to do. Paying doctors per disease is like paying firemen per fire. Would there be more or less fires? Would there be any incentive for fire departments to promote fire prevention? In a regime of totally salaried doctors costs would drop dramatically and the health of the population would markedly improve.


Health spending hits $172-billion, outpacing inflation
BY BRADLEY BOUZANE Canwest News Service
National Post
14 Nov 2008

OTTAWA  Health care in Canada will cost $172-billion this year, or nearly $5,200 for every person in the country, according to figures released yesterday by the Canadian Institute for Health Information. The independent statistical agency says that…read more…

cihi-canada-world-healthcare-cost
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From the Globe and Mail, November 19, 2009

Listening to the sounds of health-care silence

JEFFREY SIMPSON

Where did health care go? Pollsters keep reporting that health care is the No. 1 issue for Canadians. We spend way more on it than on anything else. Yet, no one – well, almost no one – talks about it any more, at least not politically.
Sure, citizens recount their experiences with the system to each other. People who work in the system talk about it incessantly, health care being their world.
But as a public policy/political issue, health care has died. Died, despite the Canadian Institute for Health Information’s reporting last week that Canada will spend $172-billion this year on health, about 70 per cent from public sources. That works out to $5,170 per capita.
Health care gobbles up provincial (and federal) resources. It consumes 39 per cent of all provincial program expenditures – that is, spending on everything but  servicing the debt. In some provinces, health care’s share of program expenditures is 45 per cent. Soon, it will be 50 per cent and higher in all of them.
Health care consumed 7 per cent of the nation’s economic output in the mid-1970s, shortly after it was up and running. Now, it consumes 10.7 per cent. That share will keep on rising as the population ages, technology becomes more expensive, and demand grows.
No one knows how to stop the increase; in fact, large increases are hardwired into government spending plans. These increases are not improving the system, but they are keeping it from getting discernibly worse.
The Paul Martin government signed a deal with the provinces for a $41-billion transfer from Ottawa over 10 years starting in 2004-2005, with the transfer indexed yearly to 6 per cent. The Harper Conservatives, then in opposition, signed on to that deal and have never wavered.
Without that federal cash, provincial health-care plans would be struggling or imploding – or provinces would be forced to raise taxes or cut other services. As it is, their annual costs are rising by 4 per cent to 5 per cent after inflation. The federal cash keeps their systems afloat.
That’s one reason why silence surrounds the health-care debate. Caterwauling provinces can hardly complain about parsimonious Ottawa when such mighty rivers of federal cash are flowing their way. Similarly, almost complete silence reigns within federal politics, except for occasional election promises to spend  yet more money for provinces to hire more doctors. But with Ottawa already sending so much money to provincial capitals, these chirpings ring hollow.
It was cheap theatre for provinces to beat up on Ottawa when the federal government seemed to be rolling in dough. But after the Harper government spent the surplus it inherited by shovelling money to the provinces for the ‘fiscal imbalance,’ cut federal revenues through reductions to the GST and let spending proceed above the inflation rate, the surplus almost disappeared.
Now, with the economic tsunami upon us, the small surplus will head into deficit. Even if provinces clamoured for more health-care money, there wouldn’t be any.
The deeper reason for the silence is that no provincial government knows what to do about the system, except to keep it going, fiddle at the edges, try to improve administration here and there, negotiate the best collective bargaining agreements they can.
Nowhere in Canadian public affairs is the gap so wide between what those responsible for policy say and what they do. Privately, almost all of those responsible know that the spending increases are unsustainable and that some means must be found to allow more public services to be delivered privately.
Publicly, none of them dare say so.
Without that debate – and fear of public reaction keeps it closed – politicians spin their wheels, spend lots of money, patch the system, add something new here and there, and carry on.
The only idea for lowering the increase in health-care costs comes from those who claim, rightly, that the fastest-rising part of health-care budgets is the drug bill. Their answer: a national pharmaceutical plan integrated into medicare.
It might be recalled that, in 1997, Quebec introduced such a drug plan. It cost the treasury about $700-million that year. This year, the public cost will be $2.3-billion, a threefold increase in about a decade.

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Health Centre Food – Not Healthy

Posted by Colin Rose on July 30, 2008

Drs Freedhoff and Stevenson are trying to do what we tried to do more than 20 years ago, change the food policies of hospitals. We have encountered all the same excuses listed below. What has taken us many years to accept and what these doctors fail to realize is that hospitals have no interest in promoting or maintaining health; they exist exclusively to treat disease. If the population were as healthy as they could be by continual vigilance in lifestyle choices there would be very little need for hospitals. Health is not profitable and will not support massive “health care” bureaucracies and unions. From the point of view of the “health care” bureaucracy and “health care” unions the ideal situation is to have a chronically sick but breathing population in constant need of “health care”, profitably supplied by said bureaucracies and unions.

Most hospital have now changed there names to some variation on “health center” and medical systems now call themselves “health care” providers, implying that only these institutions can guarantee health. Whenever I hear this I think or Orwell’s 1984. “War is Peace”; “Disease is Health”. Newspeak can exist in democracies in which self-perpetuating bureaucracies must ensure their survival by thought control and fear of death.

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CMAJ • July 29, 2008; 179

Frying up hospital cafeteria food

Yoni Freedhoff, MD, Medical Director, Bariatric Medical Institute, Ottawa, Ont.

Rob Stevenson, MD, Cardiologist, Saint John Regional Hospital, Saint John, NB

Would you like fries with that angioplasty?” Sadly, this is not as far fetched as you might imagine. Although hospitals are the front line for delivering medical treatment, health promotion and education, paradoxically, the foods they sell are frequently generic versions of fast food staples or, worse yet, brand-name fast food. Remarkably, despite nutrition’s indisputable role as one of our most important determinants of health,1 grassroots calls for hospital cafeteria reform often face resistance from hospital administrators and even some allied health professionals.

In dialogue with hospital administrators, we have met 3 main arguments against hospital cafeteria reform. First, they say they are not the “food police.” The hospital’s role need not be one of policing but rather one of health care leadership. Simply put, the sale of unhealthy foods along with the absence of nutritious alternatives undermine the institution’s role in health promotion. Although we do not propose that hospitals be held accountable for dietary choices, we do feel hospitals have a strong societal obligation to lead by example.

Second, public and institutional sentiment holds that adults are responsible for their own food choices. Consequently some people wonder whether hospitals should be restricted to selling exclusively healthy food. Although this argument has merit,what is not debatable is a hospital’s duty to empower consumers with the information required to make informed choices. Unfortunately, restaurant food choice is anything but informed. Consumers underestimate by 2 to 4 times the saturated fat, calories and sodium content of typical restaurant foods.2 However, providing accurate point-of-sale nutritional information significantly improves consumers’ choices.2 As it stands, with limited or no in-hospital nutritional information available, and frequently no nutritious alternatives offered, hospitals do not enable informed choice.

Finally, there is the question of money. Although Canadian hospitals have fewer fast-food outlets than US centres,3 the transition of their cafeterias from services to institutional profit centres is evident. We have even heard it forewarned that hospital programs could be jeopardized if healthier foods fail to sell. This alarmist warning ignores 2 of a hospital’s most important roles: the mission to promote health and the moral obligation to lead by example. Notably, in its 2007 annual report, the Compass Group, one of the world’s market leaders in retail food service delivery, including hospitals, attributed part of its rising profits to its new focus on healthy eating programs.4

Although there are no established criteria for healthy hospital cafeterias, there are healthy initiatives. California’s Sutter General Hospital enables informed choice by posting the nutritional information for a week’s worth of entrees at the cafeteria entrance. Others serve healthy choices with predominantly vegetarian menus, and there are “farm produce to hospital” programs in Texas, Vermont, North Carolina and Iowa.5 The purpose of the recently launched Canadian Healthy Hospital Cafeteria Project Survey, which one of us (R.S.) helped develop, is to identify Canadian examples of such initiatives.6

Addressing this problem will require a shift in values and thinking similar to when hospitals stopped selling cigarettes and later banned smoking on hospital grounds. Today the majority of our adult population is overweight or obese. In this fight, our dietary environment is the new battleground. Junk food is the new tobacco. Now more than ever, it is our ethical and medical responsibility to ensure that hospitals take the lead in serving foods that reflect evidence-based nutrition.

Thus, we call upon all hospitals as community health care leaders to immediately enable healthy and informed choices in their cafeterias. This would include ensuring the availability of flavourful entrees free of trans fats and low in calories, sodium and saturated fat, as well as posting nutritional information on menu boards and at point-of-sale for all foods. These first steps in cafeteria reform will help hospitals renew their focus on health and put an end to deep-fried hypocrisy.

  1. Kant AK, Graubard BI, Schatzkin A. Dietary patterns predict mortality in a national cohort: The national health interview surveys, 1987 and 1992. J Nutr 2004;134:1793-9.[Abstract/Free Full Text]
  2. Burton S, Creyer EH, Kees J, et al. Attacking the obesity epidemic: the potential health benefits of providing nutrition information in restaurants. Am J Public Health 2006;96:1669-75.[Abstract/Free Full Text]
  3. McDonald CM, Karamlou T, Wengle JG, et al. Nutrition and exercise environment available to outpatients, visitors and staff in children’s hospitals in Canada and the United States. Arch Pediatr Adolesc Med 2006;160:900-5.[Abstract/Free Full Text]
  4. Compass Group. Delivering profitable growth: annual report 2007. Surrey (UK): The Group; 2007. Available: www.compass-group.com/NR/rdonlyres/00F11551-A102-4E1C-AADD-D0DCFD95C723/0/Compass_Report_2007.pdf (accessed 2008 June 23).
  5. Gottlieb R, Shaffer A. Soda bans, farm-to-school, and fast food in hospitals: an agenda for action. Presentation at the American Public Health Association Annual Meeting; 2002 Nov 13. Available: http://departments.oxy.edu/uepi/publications/APHA_Talk.htm (accessed 2008 June 23).
  6. Canadian Healthy Hospital Cafeteria Project Survey. [To complete the survey go to www.surveymonkey.com/s.aspx?sm=CMsk1a3OrVFrbBABU6udgQ_3d_3d (accessed 2008 June 23)].

George Orwell predicted this. "Hospital" is antithetical to the "Health". "Health Centre" implies a protective, nurturing bureaucracy. No one will get sick there.

 

IMG_0194

Vending machines in the McGill University Health (sic) Center

MUHC

Partners in Disease Care. Healthy lifestyles are also not good for union employment.

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Dan, the hospital doctor, is shocked, SHOCKED

Posted by Colin Rose on July 30, 2008

This post appeared recently in the ProCOR list.

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As a medical resident I have encountered an interesting case that raises the question of reversibility and education of the pre/early diabetic group.

The case is of a 38-year-old male that presented to a screening physical examination without any complaints apart from the hardships of life. Past medical history is significant for recent diagnosis of hypertension for which he receives a calcium channel blocker. Family history is positive for type 2 diabete with his father, no coronary syndromes in his family, and his lipid profile is unremarkable. Physical exam reveiled an obese young man (BMI of 33) with controlled blood pressure and the rest of the exam was unremarkable. His initial fasting glucose was >200mg% and soon after HbA1c came back as 12. The patient denied any diabetic related symptoms. The patient was very reluctant to start any kind of diabetic regiment and strongly insisted on a sugar free diet and weight reduction only strategy. The patient went home with his own idea of managing his newly diagnosed diabetes. He did not appear for later follow ups.

But we DID meet again, two months afterwards. This time the patient is with a BMI of 27. He explained to me that he was so shocked from the diagnosis. He just started running around the block and eating a very restricted vegetarian diet. His HbA1C was 6 and fasting glucose levels were normal, and he did return to eating sugar containing foods.

Now he insisted he doesn’t have diabetes. Does he? Was he cured? Did he go back to the pre-diabetic phase? Or is he overt diabetic only controlled by diet? Was the decrease in weight that much of an influence? Apperantely so.

Dan Halpern

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As a resident in the usual hospital environment, Dan has probably been taught that diseases can only be treated with drugs and/or surgery. Coincidentally, these are the acts to which doctors have exclusive rights and for which they can charge high fees. He was shocked, SHOCKED to discover that a patient might know how to treat his own disease without the help of the vaunted American “health care” system and that what he had been taught in the hospital has very little relevance to outpatient practice.

Dan has learned a valuable lesson which he should apply to his future practice. Today most of the fatal diseases are diseases of lifestyle and the only definitive treatment is lifestyle change. Blood glucose, blood lipids, blood pressure, etc. are all markers of lifestyle in the vast majority of cases, not diseases to be treated with drugs until lifestyle has been optimized. There is increasing  evidence that some of these markers may actually be protective responses to nutritional stress analogous to a fever in response to an infection. Obviously there are varying genetic predispositions to the effect of self-destructive lifestyles but as they say, genes load the gun, environment pulls the trigger.

So, yes, Dan’s patient did cure himself of Type 2 diabetes and probably hypertension as well. He probably doesn’t need any drugs.

Now if we could only get all doctors to treat lifestyle diseases with lifestyle change before prescribing drug of doing operations we could save hundreds of billions of dollars in disease care costs, close many hospitals, shut down many drug companies and many doctors would have to make a living actually talking to patients. Isn’t that the essence of being a professionial?

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