Corrine and Barbara,
Since we seem to be starting the discussion again, I wonder if either of you
or perhaps another member of the list could tell me what you think Tommy
Douglas meant? I hope I haven't taken his words out of context.
I remember listening to him speak at a Concordia event (when I was an
undergraduate) and he seemed to be very clear in his messages.
I agree that the health of Canadians is strongly influenced by disciplines
other than medicine-especially education. A lot of what we all do could be
done by many of our patients if we gave them the information and tools to be
self sufficient. Why can't patients monitor their own blood pressure if they
want to? Why shouldn't those patients who want their test results receive them
directly with a narrative interpretation and seek further advice from a doctor
or nurse or other practioner as the patient feels appropriate?
In the current model, doctors deliver insured services, while the valuable
services of other clinicians remain uninsured. As I mentioned before we
suggested that nurses receive the same price per visit as doctors in our
clinic, and pay similar expenses but their were no bites from either
government or nurse practitioners.
Michael Rachlis noted that 1 physician and 3 nurse practioners in Saskatchewan
were doing the work previously done by 2 doctors. I'm not sure what he meant
exactly, but my interpretation of his words is that this is one way to free
ddoctors to do the work they are especially capable of doing, while other
clinicians do the special and valuable work that doesn't require medical
(physician) training. Why shouldn't people be able to contribute to a system
that allows them to decide how care will be provided and who will provide it.
I support the idea that other practioners should be reimbursed for their
services. Currently, governments can't or won't generally reimburse practices
for services of nurse practioners or other professionals.
I would be interested to hear if other members of this list feel that
governments should expand the scope of medicare by reimbursing nurses,
psychologists, physiotherapists, message therapists, dieticians, psychologists
and others to provide illness care; or if the resources should be used to
support education, economic development and direct support to the weakest
members of our society. As Dennis and others have noted there is a strong
association between income and health; wouldn't additional government
resources be better spent in other ways?
How a cooperative distributes its revenue is up to the members to decide as
they use their full set of resources to meet the cooperatives goals.
By the way if Corrinne and Barbara can suggest a way that my clinical
colleagues could work with primary care nurses we would happily explore other
models. In the current fee for encounter environment its just not possible for
the revenue in most primary care practices to support other practioners.
I would welcome hearing if any of the participants of this list can suggest a
practical way that primary care practitioners could support collaborative
practices, citizen engagement and use of modern tools and technology without
forming citizen cooperatives.
I know that in NOva Scotia some citizens have access to practices (not
currently taking new patients) that have interdisciplinary collaborations and
appropriate information technology. Why shouldn't all Nova Scotian's who want
or need access to improved primary care be able to organize to get the
enchanced and currently uninsured services they require.
Thank you for the comments and feedback, including those who have sent me
direct e-mails.
david zitner
>===== Original Message From Social Determinants of Health <[log in to unmask]>
=====
>Corrine; I applaud your letter!
>
>Barbara Rapson, RN
>Campus Nurse
>University of Winnipeg
>ph: 204 786 - 9496
>[log in to unmask]
>
>
>>> [log in to unmask] 04/07/04 02:09PM >>>
>I was fascinated to read how Dr. Zitmer attempts to co-opt the words
>of
>Tommy Douglas into support for his Primary Care Co-operatives scheme.
>Canadians DO make significant contributions to the health care system
>(which
>is, in fact, an illness care system...but that's another posting!),
>through
>our taxes. Dr. Zitmer uses this quote out of context, in my opinion.
>
>I was also struck by Dr. Zitmer's characterization of nurses as
>'professional assistants' to physicians, who allow physicians to
>'specialize
>in higher value activities'. Dr. Zitmer may be surprised to learn
>that
>nurses (along with other regulated health professionals in Canada) have
>an
>established, self regulated scope of practice independent of medicine.
>I'm
>sure that many would question the 'higher value' of activities provided
>by
>physicians. The health of Canadians is promoted by the collaborative
>work
>of many disciplines; with differing approaches, but certainly of equal
>value. I'm sure that many physicians would agree that an activity is
>not of
>higher value simply because it is provided by a physician. Perhaps
>access
>to care would be improved if Nurse Practitioners and other regulated
>health
>professionals could be fully reimbursed for their services by
>provincial
>Health Programs. Physicians currently monopolize this billing process,
>and
>are rigidly opposed to opening this up to any other health profession.
>
>I also wonder to whom these proposed monthly fees would be payable?
>Physicians? The nurses who provide the service? I find it hard to
>believe
>that anyone's health would be improved by renewing prescriptions by
>phone,
>or getting lab results by email (most people would need to have such
>results
>interpreted for them anyway). People in Ontario already have access
>to
>health information through a provincial telehealth phone line, staffed
>by
>nurses. Many Health Units also provide the same service. Dr. Zitmer
>seems
>to be proposing that people pay more for services that already exist.
>
>I suggest that Health dollars would be more wisely spent by shifting
>focus
>from 'illness care' to those approaches that can prevent visits to
>physicians offices and hospitals in the first place.
>
>
>Corrine Langill RN, BscN
>Adolescent Health Specialist, Program Development
>City Of Ottawa, Community Services Branch
>495 Richmond Rd.
>Ottawa, ON
>K2A 4A4
>(613) 724-4122 ext. 26258
>fax: (613) 724-4148
>[log in to unmask]
>
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David Zitner, M.A., M.D., C.C.F.P., F.C.F.P.
Director, Medical Informatics
Dalhousie University Faculty of Medicine
902-494-3802
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