National Trends in Health Care
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Prevalence in Chronic Disease
New data released on June 11, 2008, from the 2007 National Physician Survey (NPS) reveals that Canadian physicians are experiencing a health system under stress with patients who have complex health needs, emergency departments that are overloaded, and insufficient physician numbers due to the shortfall of broad-based generalists who are so essential for the care of older populations with multiple chronic diseases.
Generalist specialists like family physicians, internists, pediatricians and general surgeons are an integral part of the health system in this country. However, these specialties are facing resource shortages, and the NPS survey indicates large numbers plan to retire within the next two years.
According to the NPS survey, 80% of physicians overall identified the growing needs of chronic patient care is most demanding. They are seeing more and more Canadians suffering from diabetes, cancer, heart disease and mental health issues.
The needs of patients for urgent care exceed the capacity of the system to respond in a timely way. While 65% of family physicians can see a patient in urgent need of care within one day, only 37% of all other specialists can respond in that timeframe. Limited access to family physicians and other specialist physicians is putting pressure on overloaded emergency departments. A summary of the report is available on the NPS website. (Republished from the Ontario Hospital Association Executive Update – June 18, 2008)
Hospitalization Trends
The Canadian Institute for Health Information (CIHI) reports that inpatient hospitalization decreased by 14.4% (1995 – 2003) nationally across Canadian hospitals while same day surgeries increased 56.5% through the same period (1995 – 2003). More surgeries are performed on an outpatient basis (i.e. appendix and gall bladder removal) than ever before. Advances in diagnostic technologies (MRI and CT) result in quicker diagnoses and reduced hospital stays. More effective drug treatments and therapies are also reducing hospital stays
Patient stays in acute care hospitals account for the largest share (47%) of hospital spending in Canada, according to a new report from a March, 2008 report from CIHI. The report, which examined 2.4 million recorded hospital stays (outside of Quebec), estimates that on average each patient stay costs almost $7,000, with a wide variation in cost by medical condition. The study focused on the cost of treating those patients admitted to hospital for at least one night and does not include the cost of emergency care, day surgery, long-term care, hospital clinics or fee-for-service payments to physicians.
Circulatory diseases account for highest costs, followed by injury
For patients admitted to hospital, diseases of the circulatory system (for example, heart attack, stroke) cost the most to treat in Canadian acute care facilities, representing 19% of inpatient costs in 2004–2005. This is due to a high cost per stay for these patients, an average of $11,260, as well as a high volume of stays.
Primary Care
A new report from Statistics Canada issued June 18, 2008 says an estimated 4.1 million Canadians aged 12 or older are without a family doctor, either because they can’t find one or haven’t looked.
The 2007 Canadian Community Health Survey found that among those who have no primary-care physician, about 78 per cent seek medical care elsewhere.
The federal agency says 64 per cent reported going to walk-in or appointment clinics, 12 per cent went to a hospital emergency room, while about 10 per cent went to a community health centre.
The remaining 14 per cent chose to use other types of health-care facilities or services such as hospital out-patient clinics, telephone health lines or doctor’s offices.
The health services used instead of a regular medical doctor varied according to the size of a person’s community. Nearly half of rural residents surveyed said they usually visit a clinic when they need advice or treatment, compared to seven in 10 urban residents.
Almost one-quarter of rural residents reported going to an emergency room, compared to eight per cent of urban residents.
The president of the College of Family Physicians of Canada says walk-in clinics, emergency departments and other alternatives are a good safety valve in the system for those unable to access medical care any other way.
But Dr. Ruth Wilson says they are not the best choice for patients who need long-term management of chronic diseases like diabetes and high blood pressure.