In this case it's zero.
Evidence of meeting #76 for Health in the 41st Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was patients.
A recording is available from Parliament.
Evidence of meeting #76 for Health in the 41st Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was patients.
A recording is available from Parliament.
4:35 p.m.
Conservative
4:35 p.m.
General and Cosmetic Surgeon, Lakeview Surgery Centre, As an Individual
In this particular case OHIP will cover other alternatives. It will cover the gastric bypass and another procedure called the sleeve, where you create a sleeve, but it currently doesn't fund the lap band.
4:35 p.m.
Conservative
Wladyslaw Lizon Conservative Mississauga East—Cooksville, ON
It doesn't cover this. Do you have procedures that you prefer that are covered by OHIP?
4:35 p.m.
General and Cosmetic Surgeon, Lakeview Surgery Centre, As an Individual
Yes. At the beginning we were doing more and more of them. We did hernia repairs, thyroid—
4:35 p.m.
Conservative
4:35 p.m.
General and Cosmetic Surgeon, Lakeview Surgery Centre, As an Individual
It's all covered, yes.
4:35 p.m.
Conservative
Wladyslaw Lizon Conservative Mississauga East—Cooksville, ON
Let's take hernias. You have a patient and you said only the procedure is covered, the other parts of the cost are not covered. Who covers that part?
4:35 p.m.
General and Cosmetic Surgeon, Lakeview Surgery Centre, As an Individual
We absorb the cost.
4:35 p.m.
Conservative
Wladyslaw Lizon Conservative Mississauga East—Cooksville, ON
You absorb it. So you don't charge the patient.
4:35 p.m.
General and Cosmetic Surgeon, Lakeview Surgery Centre, As an Individual
No. That's the dilemma. When you look at the funding model, it's not sustainable to do it with the current structure of funding so that either then I choose to say, okay now, publicly funded procedures we'll still keep in the hospital for the time being, but in the future what we hope to see, and the provincial government has said this, is to do more and more procedures like cataracts and scopes, and I would add other procedures like hernia cases, properly and fully funded in and out of hospital facilities, much like they would fund them in a hospital, except we believe we can do it in a more cost-effective fashion.
4:35 p.m.
Conservative
Wladyslaw Lizon Conservative Mississauga East—Cooksville, ON
Therefore, I would suspect that the same procedure—in this case we're discussing hernias—if it's done at a hospital would cost more money than it costs at your facilities. Therefore, hospitals can be saving money but actually contracting you to perform the procedure. Is this happening at all?
4:35 p.m.
General and Cosmetic Surgeon, Lakeview Surgery Centre, As an Individual
The provincial government is just starting the dialogue in Ontario on that with cataract surgery and endoscopy.
But not only do we believe it's cost-effective, we believe we can deliver it more efficiently, that we can shorten the wait times substantially.
As Dr. Sutherland mentioned, when you have specific funded procedures for wait times such as cancer operations, hip replacements, cataracts, what happens is there's a collateral effect on other procedures, such as hernias and gallbladder surgery. Now they essentially, practically speaking, get bumped back, so we're getting phone calls at Lakeview Surgery Centre from patients who are getting agonizing pain, gallbladder attacks. They can't always access the hospital in a timely fashion, and while we would love to bring them in, we have the facility, we're qualified to do them, we're not funded.
But we can shorten our wait times very significantly and save the federal and provincial governments a substantial amount of money.
I believe the health care model in the future is to keep the Canada Health Act intact but deliver outpatient surgery care, such as general surgery, gallbladder, hernia, thyroid surgery, in and out of a hospital facility. You'll shorten wait times and you'll save the government substantial money.
4:35 p.m.
Conservative
Wladyslaw Lizon Conservative Mississauga East—Cooksville, ON
Okay. Now I have a few technical questions on this procedure, on this lap band. After it is installed and there is that cable with the little device, how does it work? Is it that one you adjust?
4:35 p.m.
General and Cosmetic Surgeon, Lakeview Surgery Centre, As an Individual
Yes. This is called the port, so this is a hollow—
4:35 p.m.
Conservative
4:35 p.m.
General and Cosmetic Surgeon, Lakeview Surgery Centre, As an Individual
The port is attached to the muscle in the left mid quadrant, right here in the abdomen. You don't see it. It's actually underneath, attached to the muscle. We stitch it in the muscle.
4:35 p.m.
Conservative
4:35 p.m.
General and Cosmetic Surgeon, Lakeview Surgery Centre, As an Individual
Our nurse, who also happens to have had a lap band by the way, does the adjustments. She has a patient lying down on their back with a slight arch on the back, with a pillow behind their back. Then she can palpate and feel the port. There's a special one-way needle she puts into the port and this is hollow and communicates with the circumferential balloon system, and you can fill the port with saline and, as a consequence, snug up the band, much like a belt. We lose weight, our waist goes down, and we snug it up.
4:35 p.m.
Conservative
The Chair Conservative Joy Smith
Thank you very much, Mr. Lizon. That was a very interesting question.
4:35 p.m.
Conservative
4:35 p.m.
Conservative
The Chair Conservative Joy Smith
You're so welcome.
I want to welcome Mr. Rankin to our committee.
You're up for questions now for five minutes.
February 28th, 2013 / 4:40 p.m.
NDP
Murray Rankin NDP Victoria, BC
Thank you very much, Chair.
Thank you to both of you for your excellent presentations.
I'd like to start with Dr. Sutherland. I'll take you back to your opening remarks where you identified three potential approaches that might lead to some success. You talked about activity-based funding and quality-based precedent in Ontario, and then you started—and I don't think you had time to give us much more—on the American innovations, which you called bundled payments, and on trying to break down the silos. I think you said that they might work in some provinces.
How would they work in Canada? Are there any insights that the practice might give us?
4:40 p.m.
Assistant Professor, Centre of Health Services and Policy Research, University of British Columbia, As an Individual
Essentially a bundled payment is a fixed amount for taking on all aspects of financial and clinical risk for a patient for a given period of time. For example, if you are hospitalized for a knee replacement, you're essentially given a sum, just as the federal wait times did for a knee replacement. You're given a sum for that procedure, but it covers all aspects of care, including the physician care, the hospital-based care, plus all the rehabilitative care post-hospitalization. That may be in-patient rehabilitation or outpatient rehabilitation as well as some home care.
During that time you are financially at risk for re-hospitalization. Because re-hospitalizations are very expensive, we want to provide very effective care to keep people at home and rehabilitated.
Bundled payments are being implemented as a broad policy experiment in the United States to see if they will improve outcomes and reduce the rate of cost growth.
I have actually led some research in Ontario, using their utilization databases, which has proven that bundled payments are technically feasible, so I know they are technically feasible in some locales. There are opportunities to move in that direction for a good number of conditions.