Chronic Condition by Jeffrey Simpson, Review

Western governments struggle to organize and finance healthcare, education and defense. Unlike the case of cars, wheat and whiskey, these three broad areas involve a complex production and distribution process. While each has a long history, no simple best way of delivery has emerged.

Here the focus is on healthcare, a complex system of production and delivery which is subject to rapid technological change and demographic pressures requiring increased funding.

Canada congratulates itself on its universal heathcare system. Any politician suggesting otherwise won’t last long in office. The facts tell a different story, and Jeffrey Simpson explodes the myth that all is well in the healthcare sector. Read the book to appreciate this irrefutable conclusion, and read it especially if you are interested in the care you are likely to receive as you progress from youth through adulthood to old age, the last a particular concern of mine. If not broken, the system is on life support.

Healthcare is a layered process, involving several interested parties including hospitals, drug companies, doctors , nurses, healthcare professionals, and individuals whose lifestyle decisions affect their demand for healthcare throughout their lives. When the system is publicly funded, my lifestyle choices  such as driving recklessly, consuming alcohol, overeating, engaging in extreme sports means that others pay for my expenses.

The layers include the decisions of individuals, treatment required for particular illnesses, and the costs associated with an ageing population. Healthcare delivery also has to be prepared for unexpected man-made and natural disasters such as wars, terrorism, earthquakes and tsunamis. This is a far cry from the car manufacturer who is concerned with the production, distribution and maintenance of cars. Even a massive recall is not the same as dealing with the contamination caused by a damaged nuclear reactor.

Chronic Condition examines the parts of the system which produce and deliver healthcare and shows how difficult it is to reform a complex system which has many interested parties. One example, and there are many, is what happens when governments allocate more money to the system. The immediate response is not to increase the health services but to lead those involved to ask for higher pay, whether doctors, nurses, technicians or administrators. The highest paid provincial official in Ottawa is the CEO of the Ottawa Hospital.

Simpson’s analysis and conclusions are based on numerous studies and reports both in Canada and in comparison with other OECD countries where Canada does not compare well. The difficulties of intercountry comparisons are flagged. One reason is because countries use different combinations of government insurance, private insurance and self-insurance or cash payment.

Two aspects for comment are:

1. Time magazine for March 4th, 2013 devoted almost the entire issue to examining the cost of healthcare in the US. The findings are astounding in terms of the different prices paid according to whether the service is paid for by government, a patient with private insurance or a patient paying cash. I encourage everyone to read this issue. It’s relevance to Canada is that we too have a mix of these payments – provincial government, private insurance and self-insurance or cash – sometimes with all three involved for part of the same procedure.

For example, in Ontario, hearing aids are reimbursed at $500 per ear by OHIP, part by private insurance and the remainder by self-insurance or cash. The share of private insurance depends on the terms of the policy. In my case, after the $1000 paid by OHIP for two aids, it reimbursed up to 80% of $3000 which was said to be the customary charge in my area. Unfortunately my supplier charged $4000 not $3000 leaving me with $1600 to pay instead of $800.

A patient has to be aware of the terms of the insurance and then go around to negotiate a fee. This is possible in the case of hearing aids which may seldom involve a critical treatment, but for other procedures, where time may be of the essence, the patient is in a poor position to negotiate a price with a healthcare provider. It is likely that if my audiologist had been told that a competitor was ready to supply the procedure for $3000, he would have lowered his price after telling me that the competitor was a less reliable source of supply.

2. While Chronic Condition is based on published studies, inquiries and interviews, providing the reader with valuable insight and anlysis of current conditions and how Canada got there, it has almost no value as a reference source. The absence of both footnotes and bibliography means that future students of healthcare will question whether the analysis is soundly based. They will have to go elsewhere to find the sources mentioned in the book.

Why the publisher, Penguin, would publish such a flawed piece of work is a puzzle to me, unless it wanted to save the firm money. The book has an index, but this does little to aid the reader in finding the sources referred to in the text, many of which would be available online. As an undergraduate essay, the text would be unacceptable. The book can be read as an informative lengthy magazine article, but not something considered to be a reliable piece of work, which, as far as I can tell, it is, and would be accepted as such if the publisher had insisted on a different format.

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