How Difficult Can It Get?

How Difficult Can It Get? Common Sense Health – Diana Gifford-Jones What are the true tests of a healthcare system? Is it how well it resolves health problems? How it prevents them? How efficiently it operates? One question should be, how does it treat our eldest citizens? But the fact is, it’s absurdly difficult for seniors to access care, submit claims, and navigate a plethora of disjointed systems. People pay taxes for decades. They contribute to insurance plans. They work hard, raise a family and play by the rules. Then, when they finally need help after a stroke, a broken hip or a heart attack, they are handed another form to complete, another approval to obtain, and one after another, bureaucratic hurdles to clear. In the United States, headlines have focused on insurance companies denying rehabilitation, long-term care and other medically necessary services to older patients. Many denials are overturned on appeal. But if the care was appropriate, why was it denied in the first place? How defeated are people in the process? How much illness is created, not cured? Canada likes to congratulate itself for having a different system. But Canada has its own version of bureaucracy. Long waits for diagnostic tests. Delays for specialist appointments. Programs that are nearly impossible to navigate. And yes, diabolical mayhem with making claims to provincial programs or insurance companies. If this isn’t making people sick, their medications certainly are. Everywhere seniors are juggling too many medications because physicians and pharmaceutical companies have created an epidemic of excessive prescriptions. It should be no surprise what’s happened as a result. Older people and their caregivers are beaten down. What is the price of the absurdity? Governments worry about the rising cost of caring for an aging population. But what’s truly worrisome is the failure to care at all. Getting care has become too complex – for all of us, but especially for the elderly. A national survey should ask this question, “have you given up?” Can’t get an appointment? Can’t get there if you do? Can’t get the right forms or figure them out? Don’t even know you are missing the forms? How much time and money is spent dealing with paperwork? How many hospital admissions could be avoided if someone took the time to review a senior's dozen prescriptions? How many older people deteriorate unnecessarily while waiting for approvals, referrals or appointments? These are not questions for debate. They are management imperatives. In other industries, executives measure customer satisfaction, identify bottlenecks and eliminate waste. If an airline stranded thousands of paying customers every day, heads would roll. If a bank required six approvals to cash a cheque, shareholders would revolt. The excuse is always that health care is "complex." But so is aviation. So is nuclear power. Complexity is not an excuse for inefficiency. It is a reason to manage better. What worries me most is the growing distance between decision-makers and patients. Increasingly, care is being managed by algorithms, utilization reviews, budget targets and policy frameworks. Somewhere beneath all that paperwork is an 82-year-old woman recovering from pneumonia who simply wants to go home, or an 89-year-old man hoping to walk again after hip surgery. Here's my challenge to every health minister, deputy minister, insurance executive and hospital CEO. Go spend time shadowing an 85-year-old who is trying to book an appointment – or trying to get to it. Check to see if they understand their medication list. Try to join them for a call with their physician and see if anyone answers the telephone. Then tell us that the system is working as intended and that it cares for those who need it most.