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Politics : A US National Health Care System? -- Ignore unavailable to you. Want to Upgrade?

To: Eashoa' M'sheekha who wrote (675)	4/17/2005 4:34:58 PM
From: Lazarus_Long	Read Replies (1) \| Respond to of 42652

HEALTH SERVICES QUEUES WAITING LISTS TO BE RATED. (from The Windsor Star. March 24, 2005) (Canadian Press: Saskatoon) A total of 22 health organizations have combined forces to create a list that will let patients know the maximum time they can expect to wait for service. Dr. John McGurran of the Western Canada Waiting List project explained the idea at a recent meeting of the Saskatchewan Association of Health Organizations. He said one of the project's first goals was to develop a scoring system to assess urgency of patients already on medical wait lists. "It's a novel approach," McGurran said, explaining that a num ber of factors are considered before a patient is rated from 0 (least urgent) to 100 (most urgent). As a small measure of the project's success, the priority systems for hip/knee replacement and cataract removal surgery have been put into use by the Saskatchewan Surgical Care Network. In 2003, the Sasjatchewan government also outlined a plan to have all surgeries, including electives, completed within 18 months. The project was launched six years ago. And with several other health jurisdictions already accepting the projects proposals, McGurrna says he feels the groundwork has been laid to improve many aspects of Canadian health care. www2.uwindsor.ca Background: Since waiting lists for coronary angiography are generally managed without explicit queuing criteria, patients may not receive priority on the basis of clinical acuity. The objective of this study was to examine clinical and nonclinical determinants of the length of time patients wait for coronary angiography. Methods: In this single-centre prospective cohort study conducted in the autumn of 1997, 357 consecutive patients were followed from initial triage until a coronary angiography was performed or an adverse cardiac event occurred. The referring physicians' hospital affiliation (physicians at Sunnybrook & Women's College Health Sciences Centre, those who practise at another centre but perform angiography at Sunnybrook and those with no previous association with Sunnybrook) was used to compare processes of care. A clinical urgency rating scale was used to assign a recommended maximum waiting time (RMWT) to each patient retrospectively, but this was not used in the queuing process. RMWTs and actual waiting times for patients in the 3 referral groups were compared; the influence clinical and nonclinical variables had on the actual length of time patients waited for coronary angiography was assessed; and possible predictors of adverse events were examined. Results: Of 357 patients referred to Sunnybrook, 22 (6.2%) experienced adverse events while in the queue. Among those who remained, 308 (91.9%) were in need of coronary angiography; 201 (60.0%) of those patients received one within the RMWT. The length of time to angiography was influenced by clinical characteristics similar to those specified on the urgency rating scale, leading to a moderate agreement between actual waiting times and RMWTs (kappa = 0.53). However, physician affiliation was a highly significant (p < 0.001) and independent predictor of waiting time. Whereas 45.6% of the variation in waiting time was explained by all clinical factors combined, 9.3% of the variation was explained by physician affiliation alone. Interpretation: Informal queuing practices for coronary angiography do reflect clinical acuity, but they are also influenced by nonclinical factors, such as the nature of the physicians' association with the catheterization facility. [Contents] Fair queuing for cardiac procedures requires that patients receive care in a timely fashion, with priority determined by factors such as the severity of the patients' symptoms or the risk of an adverse event occurring while waiting.1,2,3,4 Such criteria have been derived, validated and implemented to organize waiting lists for coronary artery bypass graft surgery in Ontario.2,3,4,5,6,7 However, formal queuing guidelines for coronary angiography8 have yet to be implemented, and there is little research evidence available about the management of queues for coronary angiography in Canada or elsewhere.9 We therefore examined the queuing practices for coronary angiography at a tertiary referral centre to determine clinical and nonclinical determinants of waiting times. We hypothesized that, after illness severity was accounted for, waiting times would be shorter for patients under the care of a specialist practising or catheterizing at the referral centre. We also examined whether any clinical factors, either separately or combined in an urgency rating score, were predictive of an adverse event occurring while patients were waiting in the queue. [Contents] collection.nlc-bnc.ca Another sign that the medicare system is not sustainable as currently designed is the growing use of queueing to ration health care services. 66.102.7.104 In the early 1990s, in order to eliminate its annual deficit, the federal government reduced transfer payments to the provinces for social programmes, including health care. These cuts forced the provinces to absorb the shortfall, which sparked a series of reforms including the regionalization of health services, hospital mergers and closures, reductions in the number of hospital beds and average lengths of stay, reduced access to specialized care, and longer waiting times for non-emergency surgery (Canadian Institute of Health Information, 2000a). As a result of these events, and extensive media coverage, public satisfaction with the health care system has plummeted in the past decade (56 per cent to 20 per cent) (Canadian Institute of Health Information, 2000b). utoronto.ca] If you'd like more, just let me know. There certainly is enough of it. Right wing? Gimme a break. Why is it then that so many Canadians come to the US for fast medical treatment? I've met many myself.