Sunday, October 01, 2006

Back from Alexandria

Alana and I got back from Alexandria around 7 p.m. We were there all weekend visiting Alana's dad in hospital.

Her dad went in for surgery on his back a week ago last Friday. He had some deteriorating disks and other complications, so he needed to have his back reinforced. Alana went down for the surgery and came back afterward. The surgery went fine, but on Thursday we learned that he had problems breathing. A blood clot, probably from his leg, travelled to his lung. He was moved into the ICU on Thursday.

Alana and I drove down Friday morning after I finished a couple of things at work. We saw him in the ICU and he looked better than I expected. The next morning he was transferred to a room. He's on medicine to break down the blood clot. They found others in his leg, but they were all superficial. Apparently a clot travelling like this is fairly rare. The Physician's Assistant told us that it happens maybe once a year.

As for the surgery site, it's healing fine, probably aided by the antibiotics they gave him to ward off pneumonia.

So, we stayed the weekend, spelling Alana's step-mom and helping cheer up her dad. On our off time we spent far too much time buying Logan's Christmas presents.

The trip to the hospital did allow me to compare Canadian hospitals to American hospitals.

The ICU unit at Rapides Medical Center in Alexandria, LA is essentially the same as the ICU unit at Oshawa General Hospital in Ontario. In fact, from an operational stand point there isn't much difference in an American hospital and a Canadian hospital. The American hospitals I've been in, for the most part, look a little newer; a new lick of paint, new additions. However, the hospitals I've visited in Canada have all been around for a while.

The big differences are in the way the rooms are set up. In Rapides Medical Center it appears that all the rooms are private. Most private insurance will only pay for semi-private rooms, but hospitals seem to have decided to only offer private rooms. Since people are free to vote with their feet (and wallets) private rooms are a competitive advantage.

In Canada, most of the rooms hold between two and six patients, separated with curtains. There are private rooms. My dad was moved to a private room in his last stages of cancer. Also, if you have supplemental insurance in Canada it might cover a private room.

All the rooms in Rapides had televisions mounted up on the wall. They looked like 19" TVs, maybe 21s. They weren't particularly new, but they came with the room.

In Oshawa General, the television was a small set mounted on a swing arm that the patient could pull in front of him. Since the rooms were shared, the TVs were set up so that they were only really good for the patient. They came with earphones too. Canadian patients have to pay for cable TV access. This can be bought by the day or by the week. I remember the "cable guy" coming around to Dad's room. You also had to pay for a telephone.

I don't remember there being a shower in any of Oshawa General's private room toilets, but they may have had showers. I'll have to ask Mum about it.

Of course the biggest differences between Canadian and American hospitals is cost. When a Canadian is admitted to a Canadian hospital they have to pay for a television or telephone, but everything else is covered by your provincial health care. There's a $300 (per family?) fee per year, but that covers all your medical coverage. So, yes, you don't get the private room and you don't get the free TV, but everything else is covered. In the case of Alana's parents, they have a deductible to meet, and then there is something like 20% of the hospital stay that isn't covered by insurance. This can be covered by Medicare, as her dad is retired, but they have to apply for that.

I remember six years ago reading that Canada spent 8% of its GDP on healh care while the U.S. spent 12%. I'd believe it! A for profit system is supposed to bring down costs, but there is a huge level of bureaucracy in the U.S. that adds to the cost. The bureaucracy is mostly due to private health insurance companies — all of which do things a little bit differently — and the various state health care programs, and then the federal health care program. In Canada, the provinces run their own programs (with federal oversight). Insurance companies are only brought in for the "extras".

Both countries have problems with costs, and both countries are handling it in different ways. When Dad was sick back in 1998, the Conservative Party was in power in Ontario. The Conservatives were neo-conservatives: they pushed for tax breaks for the rich. Unlike the Republicans in Washington, the Conservatives in Ontario also cut spending. The biggest line item in a provincial budget is health care. The Conservatives slashed the health care budget by closing hospitals, chopping hospital budgets and freezing salaries for nurses, etc. The hospital closings were the most controversial. Dad was cared for pretty well, except when he was at the Princess Margaret cancer hospital in Toronto. To cut cost they closed Princess Margaret's kitchen. They had their meals prepared in nearby Toronto General. By the time the food got to the 17th floor, it was pretty much inedible. I understand the situtation has improved somewhat since the Liberal Party took over, but that it still isn't what it was in the early 1990s.

Here in the States the problem surrounds private health insurance costs. The increase is much higher than inflation. Alana and I, for instance, are worse off today than two years ago because of health insurance costs. Sure, my taxes are lower down here, but the difference is pretty much eaten up by the cost of private health insurance. The health coverage cost problem is slipping into hospitals. The number of people defaulting on hospital payments is up. People are skipping elective surgery because they either can't afford insurance or they have downgraded their insurance. This is a serious economic problem, and it will get worse when the next recession hits, particularly since the states will have to pick up the slack when people are out of work. This is a ticking time bomb that few in government want to deal with.

Enough of the observations. Alana's dad has another test tomorrow and then he should be going to rehab later this week. On Saturday we rode down in the elevator with his doctor, who said he had "turned a corner". We were pretty worried about him last week, but fortunately things are looking up, even if he has many more corners yet to turn.

No comments: