Listen carefully. That sound you hear is the air being let out of the balloons – balloons once puffed up with expectations of juicy political intrigue and scandal.
After three days of Alberta’s much-anticipated Health Services Preferential Access Inquiry, there is no concrete evidence of queue-jumping by politicians, oil barons, celebrities or physicians. On Wednesday, the inquiry heard that an unnamed hospital executive asked that doctors expedite care for an unnamed VIP in the ER and doctors refused. Ho-hum.
Even Stephen Duckett, the ex-CEO of Alberta Health Services who earnestly denounced the practice in memos and speeches after being told of “preferential or expedited care for ‘prominent’ individuals,” could not provide a single example of someone buying or otherwise weaseling their way to the front of the line for surgery or other medical care.
What we seem to have here is a $10-million inquiry probing vague rumours of “fixers” and “go-to guys” – but, so far, only one “fixer” has been named and he doesn’t seem to have fixed anything for anyone. In fact, the most egregious breach of policy that has been exposed is Calgary Flames hockey players butting in line to get their flu shots early, and that’s an old story.
Then again, maybe the witnesses have all been struck with a strange case of selective amnesia and this is all part of an elaborate cover-up. Conspiracy theories abound, but, once you wade through the political rhetoric, there does not seem to be much of anything to expose.
Bottom line: The inquiry, which was called because queue-jumping and related claims had become a political distraction, is likely to prove a huge waste of time and money.
Does that mean that access to health services is perfectly fair? Of course not.
Under medicare, all Canadians are entitled to the same care, regardless of age, condition or ability to pay. But in the real world, as George Orwell deftly pointed out, some are more equal than others.
Often in the health system, who you know matters, especially when it comes to elective surgery and other health interventions where there is a wait. Politicians, from small-town mayors to backbench MLAs to cabinet ministers, also intervene on behalf of their constituents, trying to secure better, faster care. This is not always inappropriate, nor is it always effective.
These problems are not confined to Alberta, or to the health system. Nor are they going to be solved by an inquiry, by legislation or by circulating strongly worded memos.
In Alberta, as in many other provinces, there is legislation that prohibits buying or selling spots on waiting lists. But there are no clear rules about how waiting lists are compiled, monitored or regulated. Lists can exist anywhere, from individual surgeon’s offices through provincial bodies.
Heck, we don’t even have a clear method for calculating when a surgical wait begins. Nor do we have a definition of queue-jumping. If, for example, patients opt to pay for a diagnostic test like an MRI (which is legal), they can use the results to get on a waiting list for a hip replacement; in doing so, they may jump ahead of someone waiting for a “free” MRI in the public system. Is that queue-jumping? Or is it just bad management?
The most effective way to get rid of abuse, real or imagined, is to remove the opportunity for abuse. If you don’t want queue-jumping, first and foremost, you should get rid of queues. And if you have queues, then have clear rules: What are the prerequisites for getting on the list and how are patients prioritized?
More generally, to avoid people using their clout to cut corners and get faster care, you need clear definitions of tasks for employees, clear lines of authority, clear processes for appeals, accountability for decision-makers and transparency.
We have too little of those sound management principles in our health system. In fact, we have too little management, period.
Political interference is undermining the quality and efficiency of care, but not because politicians are expediting care for their buddies. The real problem is that politicians, instead of establishing policies and letting managers manage, fiddle constantly and try to micromanage the health system.
Alberta is a perfect case in point. Over the years, the province has decentralized and centralized health services repeatedly; the system has been in a constant state of flux for more than a decade, creating instability for workers and patients alike.
That’s what needs investigating and fixing. But in Canadian health care, we have a predilection for tilting at windmills rather than tackling real, systemic problems.