Drummond’s Draft

Just going through an article on Toronto Star on Drummond’s report, and especially his recommendations on Healthcare.  And these would be my thoughts as I go through the article. 

The broad recommendations include amalgamating hospitals.  The reasons could be: to bring in economies of scale and scope; cut down on executives and hence their compensation and so forth.  He hasn’t recommended horizontal or vertical integration, so I would presume he is talking of horizontal only.  I think we should also think of vertical integration.  Something along those lines is already happening in terms of hospitals opening their own family health teams (FHTs).  Who know in future, hospitals transfer their ophthalmic and orthopaedic surgeries to these FHTs whenever they are mandated to.  Also, if you merge hospitals, you also remove the number of senior executives.  These measures only reduce cost, but have no impact on the level of care.  It needs to be seen if resources freed up here are to be used effectively elsewhere.

He recommends a 20yrs plan to drive down his 105 recommendations.  It makes sense to have such a long term plan, as it always better to tweak a plan than the current policy.  As he himself states

“To avoid short-term pain caused by quickly made policy decisions, Drummond feels the 20-year prescription needs to be followed.”

I haven’t had a chance to glace through the 105 recommendation, but shall do it over a time.  Meanwhile he is against further increase in physician compensation.   Fine!  But what has to be noted is that the biggest cost is not physician compensation, but costs due to doctors.  The multiplicity of tests and visits, are the ones that need to be curtailed.  Not blaming the physicians, but system should be such that duplications is avoided (hinting at system wide EPR).  

Good he is keeping the LHINs, as some sort or region focused approach is required.  What needs to be looked into is why they failed to live up to their expectations.   Strengthening them the right way would be the way to go.  Also, he is kind of hinting at often discussed model where hospitals serve as node and develop some sort of working arrangement with community agencies.  And, I’d like to thank him for solving the downtown headache by suggesting that Sickkids, Pricess Margaret Hospital and CAMH be kept aside due to their specialized role. 

He is against further increase in physician compensation.   Well! Nobody expected in such hard times, but thanks for making things clear and setting right expectations.  And also clarifying the point that doctors need not be consulted about what is included in OHIP and not.  It is purely for the government to decide what it wants to pay for, and what it doesn’t. 

Has endorsed what was stated in Bill 46 that executive compensation should be linked to patient safety and not number of procedures.

Good to align public health agencies with LHIN.  There is no great need to reduce their number to match that of LHINs.  Basically, these agencies shouldn’t straddle across LHIN boundaries.  If need be there can be more than one public health agency in a LHIN, but they should not cross the boundary. 

Good to see stress being given to preventive health measures.  These, and these alone can help cut down drug cost.  You just cannot/should not prevent physicians from prescribing newer expensive drugs.  Same holds true for diagnostic tests.  The only way out of the situation is preventing from falling sick. 


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