Do we dismantle the hospitals?

The Globe and Mail. (2014). Why the future of health care may depend on tearing down the hospital. [online] Retrieved from: http://www.theglobeandmail.com/life/health-and-fitness/health/the-hospital/the-future-of-health-care-may-depend-on-tearing-down-the-hospital/article17030106/?cmpid=rss1 [Accessed: 24 Feb 2014].

The article is about tearing down the hospital in favour of a network of community health-care centers.  It gives an example of a patients with comorbidities who had been in and out of the hospitals several times.  The argument being given is that the current system hasn’t helped the patient in long-term remission and the whole ordeal has been costly for the system.  The article further states that the current health care system is acute care centric and offers no additional benefits to such patients.

I would agree with the latter part, but we do need to have an alternative in place before we start tearing down these hospital.  What would have happened had there not been that tertiary care hospital?  Is our community based infrastructure ready for such patients? 

Further, the article talks about how such patients get caught up in vicious cycle of deterioration at home, only to return to the hospitals.  I would argue that this is what the hospitals are meant for.  Treatment in the community is best left for such diseases which can typically treated in ambulatory settings.  Patients with such comorbidities cannot be treated successfully in community hospitals, let alone in community health care centres. 

The article again brings to foreground that various innovative physicians have a solution, which is getting rid of the hospital to begin with.  They argue that their community based model will provide services such as physiotherapy, social workers etc.I would argue that before we think of that, we must have an alternative ready and successful.  There is no guarantee that such drastic measures will bear favourable results.  The unfortunate part is that the proponents of community based model are targeting the kind of patients that need the hospital setup the most. 

There is an argument put forward that channelling money towards home and community care without dismantling the hospitals would be counterproductive.  As this is something that will only increase the costs.  I would consider such a suggestion quite preposterous.  How can one do away with hospitals without any kind of alternative in place.  As all would agree, the transition away from the hospital has to be gradual and calculated.  The proponents, however, believe that there are many services, like tests, that cannot be administered from home, thereby contradicting themselves.  I would suggest that efforts should be made to use telemedicine more effectively in conjunction with home and community care, before efforts are made do reduce burden on the hospitals.  The articles does agree, however, that just spending money on home care won’t deliver desired results unless it is coupled with services to fully integrate the system.

The article gives an example of how the paramedics had take an intoxicated patient to the hospital, and by the time he could be admitted, he had already recovered and walked off the emergency.  I would recommend that the proponents of the community model should rather me concentrating on such patients.  We need to explore why paramedics couldn’t have taken such a patients a community based organization in the first place. 

The articles gives an example of a clinic in a homeless shelter, which welcomes patients brought by police and paramedics.  It goes back to the previous example, and elaborates how their small venture has expanded to more beds for homeless, and provide services of nurses; personal-support workers; additions; counsellors; and social workers.  I believe this would be a great starting point of integration and shouldering responsibility, rather than big ticket comorbidity ones. 

The article highlights another set of opinion that presence of a hospital based system prevents any innovation from taking place in the community.  I would argue that it is not hospitals’ fault, but lack of culture of innovation in the system.  Also, the impression in the public is that hospitals are meant for emergencies or serious conditions.  I really wonder how many really go to hospital out of choice?  I believe here lies the opportunity for making the Community Health Centres (CHC) more visible.  There should be an effort on their part to reach out to the public.  After all, do people even know what all services are available at their nearest CHC? 

Further, it elaborates on a particular shining example of innovation in community based settings at a Family Health Team (FHT).  I believe that here lies an opportunity for creating a governance structure to share such ideas.  I am not sure, but I would take the liberty of recommending this to the Association of Family Health Team of Ontario (AFHTO) to take up a leadership role in this regard.  At the time, involved LHINs so that they are aware of the ground situation, and gauge and plan any move from hospital to community sector.     

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