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Alberta health care queue-jumping inquiry - Findings and recommendations

Alberta health care queue-jumping inquiry - Findings and recommendations

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Published by John Turner
The Health Services Preferential Access Inquiry Report - Read the finding and recommendations from the judicial inquiry into reports of queue-jumping in Alberta's health-care system.
The Health Services Preferential Access Inquiry Report - Read the finding and recommendations from the judicial inquiry into reports of queue-jumping in Alberta's health-care system.

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Published by: John Turner on Aug 21, 2013
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08/21/2013

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Volume 1:Inquiry Report
SECTION V: CONCLUSIONS ANDRECOMMENDATIONS
I started this report by saying that the Canadian health care system is premised in part on the ideal of equitable access to necessary physicianand hospital services
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the principle that access should be determined by medical need. This principle is really a subset of a much larger conception of health care as a vehicle of distributive justice
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the ideathat health care should be distributed in an egalitarian manner so thatno one is denied the care he or she needs simply because of non-medical criteria, such as an inability to pay.Improper preferential access to publicly funded health servicesundermines those principles. However, as I discussed in this report,certain types of preferential access may be proper 
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that is, ethically or socially justifiable
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despite the equitable access principle. Oneexample may be front-line health workers receiving vaccinations aheadof the general public during an influenza outbreak so they remainhealthy enough to vaccinate others. But society has yet to determinemost of the situations where it will accept preferential access as being proper. The broadly based public discourse needed for suchdeterminations has not yet occurred.This inquiry has investigated incidents that revealed improper  preferential access
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the vaccination of professional hockey playersduring the H1N1 pandemic in 2009, some nurses vaccinating friendsand family during that same period, and patients being fast-tracked for screening colonoscopies. These incidents are not representative of thehealth care system as a whole. However, they show certain parts of thesystem and the opportunities that may exist within it for improper  preferential access.The inquiry has also examined various practices that may open upavenues for improper preferential access
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such as professionalcourtesy and what has been called the private patient path. These are practices that could benefit from a more considered analysis, and policies about them need clarification.The recommendations in this report address the systemic issues arisingfrom the incidents and practices examined by this inquiry. Somerecommendations may be regarded as going beyond the strict
 
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Conclusions and Recommendations
 
 parameters of this inquiry’s mandate. However, one cannot examine
improper preferential access without looking at some of the systemiccircumstances that lead to it
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primarily lengthy wait times for consultations and procedures
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and the possible measures available toaddress those circumstances.This inquiry has clearly demonstrated that myriad opportunities existfor improper preferential access in the health care system because of the multiple ways to access that system and the wide discretion grantedto physicians, other health care professionals and administrators.Lengthy wait times throughout the system also foster the motivation to jump the queue. That is human nature. And, as was repeatedly saidduring this inquiry, there would be no need to examine queue-jumpingif there were no queues.One must ask whether it is realistic to think that measures can be put in place to eliminate improper preferential access altogether. Are theresimply too many holes to plug? And a further question must be asked
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 at what cost? Even if a system could be designed to guarantee that therewould be no improper preferential access, there would certainly be animpact on how physicians, hospitals and clinics operate and organizetheir workloads. There is merit in maintaining the flexibility needed tomeet the differing needs of patients. That is why most of therecommendations of this inquiry promote collaboration among variousgroups interested in health care to improve policies and guidelines, notmandatory rules and procedures.The mere fact that this inquiry has been held may very well havecaused people working in health care to consider the issue of improper  preferential access more carefully and, if necessary, to modify their  behaviour.The literature review conducted for this inquiry found a lack of empirical evidence regarding the impact of improper preferential accesson the health care system as a whole. The inquiry found no evidencethat a patient had suffered adverse health consequences as a result of any of the incidents and practices of improper preferential accessexamined. What improper preferential access exists in the system
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apart from areas such as workers’ compensation cases, where
legislation creates a system of preferential access
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involves anextremely small percentage of the total cases in the public health caresystem. If very few persons benefit from improper preferential access,
 
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Volume 1:Inquiry Report
and there is no evidence of others being harmed by it, there may be nosignificant threat in practice to the egalitarian aims of our health caresystem.However, the perception remains that some receive faster access tohealth care because of status or connections, not medical need. This is just as damaging to confidence in the public health care system as theactual cases of queue-jumping identified in this report. Those whodeliver health care must be prepared to challenge the perception as wellas address the reality.The expert witnesses who testified at this inquiry cited education as ameans to reduce improper preferential access and increase publicknowledge about the workings of the health care system. Education canhelp medical professionals understand the potential harm that can becaused by improper preferential access and the systemic harm thatresults from public perceptions of the extent and unfairness of improper  preferential access. It can help distinguish between ethical physicianadvocacy and advocacy that crosses the line into pressure for someimproper preference. Educating the public can help alleviatemisunderstandings about how the health care system functions and alsospur greater public involvement in discussions about all aspects of the
health care system. The sustainability of Alberta’s public health care
system depends in large measure on involving the public in addressingthe challenges facing the system and developing solutions for thosechallenges.Improper preferential access is a minor component of the public healthcare system. However, because of the public perception about theextent of improper access, this issue corrodes public trust in the system.I hope that, with this report and these recommendations, the work of this inquiry will lead to measures that will reinforce that trust.

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