Access without Appropriateness: Chicken Little in Charge?
Raisa B. Deber, PhD Department of Health Policy, Management and Evaluation, University of Toronto Toronto, ON
Then, the second idea intrudes: Publicly funded healthcare is unaffordable. The system is not sustainable. We need cost control. A brave few point out that our current bottlenecks result from the success of earlier cost control efforts: per capita inflation-adjusted Canadian health expenditures actually dropped in the mid-1990s. Funders capped hospital budgets, providing, in turn, an incentive for cost shifting. Hospitals laid off nurses; the resulting exodus from the profession soon created a nursing shortage. Physicians had to battle for operating room time; those with less internal power (often the providers of elective surgery) found themselves on the losing side, leading to wait lists for their services. The backlash, in turn, led to the current focus on restoring resources. A cynical observer might suggest that there will soon be a similar backlash against the costs of the access agenda, particularly if the economy slides into recession.
Priority 2: A situation that involves some pain and disability but is unlikely to deteriorate quickly to the point of becoming an emergency admission should be operated on within 90 days.