9/17/18

A Comparison of Health Care in Canada and the United States


Health care reform in the United States is a notion long in the making. Growing concern over medical costs and availability of care has led to large-scale debate over the future of the American health care system. Eyes have turned north to Canada to compare their universal system of health care with that of the U.S. The question is, can the Canadian model improve care available to all citizens, while keeping the costs down?
The Canadian and American health care systems are worlds apart, from their acquisition of funds and government involvement, to the costs, delivery, and even outcomes of the systems. The Canadian system is funded through a single-payer system (the government), through tax revenue. The government pays for almost all of the medical costs. The benefits of this system include accessibility to services for all residents and lower administrative costs. The drawbacks of the single-payer system include long wait times and staff shortages due to lack of funding. The American health care system uses funding primarily from private sources, and most residents have access to a variety of insurance plans. The administrative costs associated with the numerous insurance companies are extremely high.
In a survey on health care satisfaction, Americans were found to be one third less likely than Canadians to have a regular medical doctor, one fourth more likely to  have unmet health care needs, and are more than twice as likely to go without required medication. These numbers increase substantially for the uninsured.  According to the study, more U.S. respondents had unmet health care needs than did Canadians (13.2% and 10.7%, respectively), however, their reasons for having such needs differed. 7% of U.S. residents (and less than 1% of Canadians) had unmet needs because of finances, whereas 3.5% of Canadians had unmet needs because of long waiting times. U.S. respondents cited wait times as less than 1% for reasons behind unmet needs.  The barrier to meeting health care needs in the U.S. is the cost; in Canada, wait times are the main offender. The data suggests that Canada no longer enjoys greater satisfaction with its health care than does the United States. It seems plausible that Canada’s far lower health spending compromises aspects of care that affect satisfaction but not health outcomes.
The same health study observed at least 17% and perhaps as many as 21% of Canadian women are not receiving recommended cervical cancer screening. This deficiency may reflect low reimbursement rates for this service in Canada. However, death rates from cervical cancer have historically been lower in Canada than in the United States, possibly due to past screening practices and population risk factors.  According to the Organization for Economic Co-operation and Development (OECD), the U.S. has an exceptional track record of early cancer detection and treatment.

 Canada’s single-payer system for physician and hospital care is far more efficient in comparison with the American multi-payer model when looking at administration. Hospitals that are not-for-profit have considerably lower payments to third-party payers in comparison to for-profit hospitals, while also achieving lower mortality rates. Canada’s single-payer system, which relies on not-for-profit delivery, achieves health outcomes that are at least equal to those in the United States at two-thirds the cost. Some research into the issue of single-payer systems has shown the administrative costs of billing individual private insurance companies can be reduced by 20%. That would be a savings of roughly 200 billion per year in the U.S.

Despite the arguments that universal health care bears a hefty price tag, the U.S. spends significantly more per year on their health care. According to the OECD, Health care spending as a percentage of the Gross Domestic Product in 2007, Canada spent approximately 10%, while Americans spend 16%.  Americans spend significantly more on their health care per year than any other country in the OECD. A recent report from the organization also reveals that 35% of total health care expenditures is done by private health insurance which is the highest in OECD countries. Regardless of the high medical expenditures, the U.S. has fewer doctors per capita than most other countries in the organization.
The accessibility to medical services without charge is beneficial to those residents with lower incomes. Although there is little difference in the numbers of Canadians and insured Americans with regular medical doctors, in the U.S., approximately 16% of the population is without insurance, and 20 million in the U.S. are underinsured.  One-third of the uninsured are in the lowest income quintile. The likelihood of uninsured residents seeking regular medical attention for preventive care or otherwise, is fairly low. Public insurance is available to seniors, the military, veterans, the poor, and the disabled, but this is not universal. As well, insurance premiums and deductibles continue to rise. Health care costs are increasing, placing added financial burdens on the U.S. residents. As the “baby boomers” continue to age, health care costs are expected to increase substantially in the next few years.
Despite the massive spending on health care, life expectancy in the U.S. is lower when compared with Japan, Switzerland, Canada and Australia, and infant mortality rates are higher than in most OECD countries. In 2006, it was 6.7 per live births relative to OECD average of 4.7. Obesity rates among adults is the highest in the U.S. at 34.3% in 2006. Higher obesity rates leads to higher health care spending in the future.
The U.S. continues to be at the forefront of health care research and technology, perhaps due to the for-profit nature of many of the health institutions. There are some critical problems with the American health care system that could be remedied in a number of ways. Looking at the universal system in Canada has shown there is a way to have accessibility, while also keeping the costs down. American policy makers will continue to investigate the system differences in the two countries, hopefully resulting in ways to successfully navigate the health care issues in the U.S.


 Notes:
"Access to Care, Health Status, and Health Disparities in the United States and Canada: Results of a Cross-National Population-Based Survey". American Journal of Public Health 96 (7). 2006.
“Comparing Health And Health Care Use In Canada And The United States”. Health affairs 25 (4). 2006: 1133 -1142.
G.H. Guyatt.  A systematic review of studies comparing health outcomes in Canada and the United States. Open Medicine 1 (1). 2007.
Karen E. Lasser, David U. Himmelstein, and Steffie Woolhandler. “Access to Care, Health Status, and Health Disparities in the United States and Canada: Results of a Cross-National Population-Based Survey.”  American Journal of Public Health 96 (7). 2006. Retrieved From:
http://www.pnhp.org/canadastudy/CanadaUSStudy.pdf.

Philippe Le Goff. “The Canadian and American Health Care Systems: Funding and Effectiveness”. Parliamentary Information and Research Service 17. 2005. Retrieved From:                                           http://dsp-psd.pwgsc.gc.ca/Collection-R/LoPBdP/EB-e/prb0461-e.pdf
OECD Health at a Glance 2009: Key findings for the United States. Retrieved From: http://www.oecd.org/document/21/0,3746,en_2649_37407_44219221_1_1_1_37407,00.html
“The U.S. Health Care System: Best in the World, or Just the Most Expensive?” American Medical Student Association 1.2001.

8/29/18

Reader's Digest Ten Things You Didn't know about nurses.

A Reader's Digest article was posted and has an interesting list of 10 things you didn't know about nurses. What would you add? Do you think it's accurate? The list includes


  1.  Nurses are expected to know everything 
  2.  You don’t always know where you stand with patients 
  3.  Sometimes nurses have to disobey orders 
  4.  Nurses are taught that patients are their primary focus. 
  5. Nurses handle an abundance of bodily fluids (Duh)
  6. Families are demanding
  7. Nurses do a lot of heavy lifting profession
  8.  Nursing school doesn’t prepare you for everything 
  9.  Nurses often work beyond their scheduled time 
  10.  Nurses may be responsible for a lot more than patients

Although not specific to the ER, these are generalizations that include ER nurses. Here's the link for more. https://www.rd.com/advice/work-career/surprising-things-about-being-a-nurse/

8/22/18

What do you make?

Emergency room nurses earn a median salary of $63,443 per year in the U.S., according to Payscale data. (These numbers are likely higher in a union setting.) Here are eight notes on annual ER nurse compensation: 1. ER nurse salary ranges from $41,688 to $92,098. The wide range varies based on experience, location, union, and public vs private setting. 2. They can earn up to $7,851 and $12,480 in commission. 3. Profit sharing for ER nurses ranges from $102 to $9,787. 4. ER nurses can earn anywhere from $47,825 to $94,818 in annual income before overtime (if you're eligible for such compensation). 5. ER nurses with less than five years of experience receive around $57,000 in annual salary. 6. Nurses with five to ten years of experience, earn on average $64,000. 7. Average salary for ER nurses with 10 to 20 years of experience is $73,000. 8. Late-career ER nurses, with 20-plus years of experience, receive on average $77,000 in pay per year. These are all in USD. How do you stack up? Hopefully not underpaid....

12/11/17

The dumbest or biggest waste of time someone has checked into the ER for?

The common cold? Hangnail? What are some of the most ridiculous moments you've encountered of grown adults coming into the ER, tying up resources, you've experienced?

11/28/17

Have you, or when was the last time, you lied to a patient or their family?

Have you ever been in a circumstance where you lied to a patient or their family? There may come a time when you are trying to relay information and the family doesn't comprehend what's happening, and you may, say, save someone's feelings with a white lie. Are there instances where it could be for the better, to help families or patients cope with loss. here's a story from Allnurses.com worth reading. Warning, it's a tear jerker.
I got the call on the EMS radio around 5 am. This is the usual time we get calls from EMS responding to nursing homes- The nurses are rounding on their patients to give am meds, and they find their residents dead or in distress. An 87 yo female, febrile, and in severe respiratory distress coming in. Pt is a DNR, but family is very involved, is aware, and will meet them in the ER. I'm alerted that family is in the waiting room before the patient even gets there. I go out and introduce myself, tell them I will be her nurse, and that I will bring them back as soon as I get her settled in the room. EMS arrives, and carefully transfers their frail burden onto one of my stretchers. You can see the relief on their faces, that they got her here and are able to hand her off before she dies on their watch. I'm now the proud owner of one very ill person. Temp 102+, Respiratory rate 14 and irregular. HR 50's, sat 84% on NRB, I don't need my Littmann to hear the rhonchi- Other hx is advanced dementia, DM, CHF. Has been in the nursing home for about 6 months- her husband had taken care of her at home as long as he could, but it finally got too much for him to manage, as he was also dealing with his own health problems at the age of 92. I got her settled, and the Doc comes in- I give him the pertinent info- Not a whole lot we can do at this point other than make her comfortable and treat the infection. Chances are poor that she will make it, and we both know it. Doc moves on to deal with people he can help, leaving me in control of this mess. I bring her visitors in, including her only daughter in her 60's, and several close friends of the family. I get them settled in and TRY explain to them what is going on. They don't get how bad off she is- I try to explain it to them in soft terms- They share with me who she is- a wife, a mother, a friend.I learn her husband is frail and elderly. I strongly suggest that if he is able, that he come. The daughter tells me she is going to leave to go get Dad. I explain that mom could go at any moment, each gasp she takes could be her last. I don't want them to have to deal with the idea that she died without ANY of her family around. But I REALLY wanted her husband there. The daughter calls her husband, who is dispatched to go get him dressed and here. In this age of technology, we can keep up with a lot of things. I'm updated that son in law is at dad's house, he's getting him dressed, getting him loaded in the car with the wheelchair. I'm watching my patient brady down, 50's, 40's 30's....The monitor is alarming, and my pt.'s daughter sees it. Husband lands in the parking lot, and the son in law is getting him loaded in his wheelchair. Then she died, no resps, asystole on the monitor. The daughter asks me- "Is she gone?" ..... Read the rest here: http://allnurses.com/emergency-nursing/i-lied-a-960234.html

11/7/17

Nursing Practice During a Disaster: Some Considerations

Nursing is by nature a profession based on caring compassion and the desire to alleviate suffering and facilitate healing. The nursing profession has and will play a vital role in the response to any disaster. This fact has been acknowledged by the Institute of Medicine(IOM) in their report The Future of Nursing Leading Change and Advancing Health. The IOM has also created the report titled Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations. The nation has coped with disasters such as the 9/11 terrorist, hurricanes, and pandemics. Some disasters require an all out immediate health care response, other disasters require a more planned response over a longer period of time. The IOM has distinguished disasters by calling them pervasive or catastrophic. However, every disaster requires a different allocation of resources, and maximum output of health care personnel. Care decisions are made in a compressed time frame and the standard of care will change. The standard of care that is able to be implemented is known as a crisis standard of care, is executed by the presence of certain circumstances and at present is formally declared by a state government. Preparation before a disaster is essential. There are many questions that nurses would have in deciding how to respond in a disaster. What are a nurse’s professional and personal considerations? Effectiveness means getting the answers beforehand, as almost any nurse will feel a professional obligation to assist in a disaster if needed. This article will pose some questions nurses might have in an attempt to provide tools to help a reader make an informed decision. The IOM has recommended national standards and protocols in any disaster response. Currently only some states have disaster contingency plans. The IOM with input from professional organizations such as the ANA has prepared a report that outlines suggested procedures. The ANA has its own policy paper as well. The Red Cross is also establishing scope of practice for nurses in their disaster response which includes nurse managed shelters. It is called the Disaster Health Services Concept of Operations. The IOM has stated that 5 elements must comprise any national policy on disaster response. They are: That any plan has a firm ethical foundation, and there be community and provider engagement and education that are continual and integrated. There must be assurances on legal authority and environment. Clear triggers, indicators and responsibilities, which employ evidence based decision making processes.are necessary. Here are some of the questions nurses might have about their professional role in a disaster. What capabilities will I need to practice effectively? The Columbia School of Nursing has composed a list of core competencies for clinicians in disaster healthcare. For a health care professional the following is a brief summary of emergency preparedness skills: Responding to the emergency within the incident or emergency management system of the particular organization or entity. The ability to explain one’s role in the disaster response. Initiate patient care according to licensed ability and coordinate referrals to an appropriate agency according to the patient’s condition. Be able to recognize sickness, disease, or injury that is a consequence of a number of agents natural or manmade. The ability to put in place infection control procedures to reduce spread of disease, which will include decontamination and use of protective equipment. Recognize and manage stress and anxiety created by the disaster and refer if necessary. Communication is a large part of several competencies as clinicians will need to both receive and convey information about the disaster, for example to facilitate updates. They will also have to interpret information received and summarize care given to patients and also participate in post event evaluation. What would be my scope of practice? What the legal protection is in place to protect me in my practice? The IOM report stated that professionals need to be clearly protected in order to allow health care professionals to practice without fear of legal action as long as they are acting in good faith and not recklessly. Although comprehensive liability protection is in place medical personnel are protected if they act under an emergency declaration as part of a team, for example. The IOM has recommended that existing liability protection be tied to linked to the declaration of crisis standards of care. An ethical foundation allows for confident provider response and action. Clarification and standardization of protocols will encourage nurses to respond in a disaster. If my present employer doesn’t have a disaster plan response where can I get training in disaster nursing? Be knowledgeable about your employer’s emergency preparedness plan if your medical center has one. Get involved in advocating to your peers the importance of creating a plan. Also be aware of your state’s response protocols are. Nurses can also train with organizations that would respond in a disaster such as the Red Cross, Disaster Medical Teams and the Medical Reserve Corp Standards of care in a disaster will differ from health care on a regular basis. Any crisis standard of care must be applied consistently and with transparency. All this must be contained in a policy that has been developed pre disaster by a disaster medical advisory team using evidence based decision tools and algorithms. In a disaster health care professionals’ goal must be to provide the care for the greater good of a larger number of patients. Nurses must confidently rely on their professional experience to make up for the lack of technology, staff, or support services available. Also utilities and infrastructure to administer health care may be damaged. One point that has been proven in any disaster is that vulnerable groups of society suffer the most both during and after the event. As mentioned earlier, community engagement is necessary in any disaster response plan, both for it to be executed successfully and for the recovery of citizens after. This is where nurses’ professional skill and unique position of trust in the public’s eyes will mean they are the health care professionals best positioned to elicit and maintain constructive productive dialogue with the public before, during, and after a disaster. Policymakers would do well to note the public’s trust in nurses and put them in positions to engage the public in disaster response planning. Sources: http://nursingworld.org/MainMenuCategories/WorkplaceSafety/DPR/Disaster-Preparedness.pdf http://nursingworld.org/MainMenuCategories/WorkplaceSafety/DPR/TheLawEthicsofDisasterResponse/AdaptingStandardsofCare.pdf http://www.nap.edu/catalogue/12749.html http://nursing.advanceweb.com/News/National-News/Nurse-Led-Disaster-Response-Model-Aligns-Red-Cross-With-IOM-Goals.aspx?cid=xrs_rss-nd

10/16/17

Burnout - From the ER and Beyond, Healthcare Workers at Risk

With a rising awareness real mental health, one of its aspects seems to lack practical application in the workplace. Nursing, and healthcare professionals, know that their job is fast-paced, sometimes at break neck speed, role that demands significant focus and investment in all ways. That includes mental and physical weight that can have adverse effects if nothing seriously. We have seen many healthcare professionals, not the least of which are nurses, have to take long extended leave, or worst, leaving the profession entirely because of burnout. The question for discussion is this: How does your workplace treat burnout? The startling reality is that burnout happens, and you need to take care of yourself. However, workplaces seem to ignore this reality and do not have adequate mechanisms in place to help their employees. The culture of overworking is one that's leaving unhealthy nurses in its wake. Are there programs in your workplace that are helping? What have you seen work? What do you do for yourself to ensure holistic health?