Coming home for TLC

[Gunner98]

Being around the block a few times does not mean you know how things work today, it has changed a lot in the last 6 years.  Most (95+%) CF medical bills are now paid through a contract with Atlantic Blue Cross by CF Director of Health Services Delivery, the federal government does not pay the bills.  It comes out of the DND budget.  Unlike when we paid the bills through PWGSC (the federal government), the bills get paid even faster than they used to.  The provinces do not regulate the individual providers and have little control over individual hospitals when it comes to serving soldiers. Your Blue Cross card does not guarantee service although in most cases it will.  Until recently some providers required money up front for eg. CT scans, this is less common today.

Many of A'stan-experienced CF specialists (Surgeons, Internal Medicine) work in Edmonton's Univ of Alberta Hospital, the Ottawa Civic Hospital, the London Health Sciences Centre, the Halifax's QEII and at the Vancouver General's Trauma Centre, they are providing some outstanding continuity of care to our soldiers.

 

[Gunner98]

Geo said, "Where do you get the uninsured customers??? The CF and the RCMP are undiscounted full payment customers.  The Fed gov't pays for every intervention, tongue depressor, ear squib, cough drop, etc...... we are not a provincial charity case."

This phrase "undiscounted full payment customers" is catchy but from what government document did you draw it.  I suggest you read the following closely and see how soldiers are regarded under The Canada Health Act which states@ http://www.hc-sc.gc.ca/hcs-sss/medi-assur/res/gloss_e.html

"An insured person is interpreted under the Canada Health Act as a resident of a province or territory other than:

a member of the Canadian Forces;
a member of the Royal Canadian Mounted Police who is appointed to rank therein;
a person serving a term of imprisonment in a penitentiary as defined in the Penitentiary Act; or
a resident of the province or territory who has not completed such minimum period of residence or waiting period, not exceeding three months, as may be required by the province or territory for eligibility for or entitlement to insured health services."

Therefore, we have the Canadian Forces Spectrum of Care http://www.forces.gc.ca/health/services/engraph/spectrum_of_care_home_e.asp?Lev1=1&Lev2=5

1. The Canadian Forces Spectrum of Care (SOC) document was first published on 21 December 1998 to describe the health care benefits and services, medical and dental, that are available and publicly funded for members of the CF and other eligible persons. The SOC is published by the Director General Health Services under the authority of CMP and it is updated regularly.
2. The document provides direction to CF health care providers, Health Care Coordinators (Base/Wing Surgeons) and Dental Detachment Commanders. It also authorizes the utilization of public funds to ensure that CF members have access to a comparable standard of health services as Canadians receive under provincial health care plans.

 

[lostrover]

Seeing as the payment issue has been defined...

OK, a lively discussion here in reference to payment, but what I'm concerned about (deploying soon) is the care I am to receive if I'm hurt.

My opinion is that I would rather be in a military hospital (in Europe/US/wherever) that specialises in whatever injury I have. For example, if I am hit with an IED, and suffer blast, burn, numerous broken bones and penetrating trauma, is the best place for me the University hospital here in Edmonton? Would I not be better off in a facility that deals exclusively with this sort of injury?

Given that different medical facilities have different specialties (ie Cardiac/palliative/oncology) and this provides a higher standard of care, is the same not true for battlefield injuries?

Seeing as foreign facilities have been dealing with these types of injuries intimately for many years, I too share the same opinion as GO!!! with regards to treatment, till such time as substantive information can be present to rebut my opinion.

 

[observor 69]

OK, a lively discussion here in reference to payment, but what I'm concerned about (deploying soon) is the care I am to receive if I'm hurt.

My opinion is that I would rather be in a military hospital (in Europe/US/wherever) that specialises in whatever injury I have. For example, if I am hit with an IED, and suffer blast, burn, numerous broken bones and penetrating trauma, is the best place for me the University hospital here in Edmonton? Would I not be better off in a facility that deals exclusively with this sort of injury?

Given that different medical facilities have different specialties (ie Cardiac/pallative/oncology) and this provides a higher standard of care, is the same not true for battlefield injuries?

I agree, can the less wealthy provinces provide the best care available in Canada. Am I better of in Sunnybrook or in a smaller, less well funded hospital such as Saint John Regional, no offense to all my relatives who work their? Take my broken body to the place I can get the best care please and thank you.

 

[geo]

Given what is going on in most major urban centres every day, local hospitals in major centres are intimately familiar with wounds from gunshots, bomb blast, burns, vehicle collision, PTSD (Dawson, Polytechnique, Concordia).  They are able to dispense treatment topert much all cases that the CF can throw at them.  Smaller centres may be challenged but, the medical network (Civ & mil) should be in a position to ensure these centres are capable of dispensing care before sending anyone there.

 

[Edward Campbell]

Guys get with the program. Yes care is guaranteed full stop and while the health care system does its level best we are generally well looked after. Our Med plan compared to the lions share is heads and above most out there.

And the fact that our 'system' is somewhat better than most (in Canada) is supposed to be some sort of recommendation?  Good, indeed excellent medical support is an operational requirement.  The taxpayers have a right to a fit, healthy army; one in which most soldiers are ready and able to fight.  The aim ought to be to return wounded soldiers to duty as soon as possible or make them ready to rejoin the civilian world in as productive a capacity as humanly possible.  If the system is not achieving its required levels of performance then perhaps it needs more and better resources or, perhaps, we can just lower the standards again - so as not to get too near the level of care afforded the careless bricklayer. 

The CF has a difficult enough time attracting Med people both Doctors and Nurses let alone keeping them in. How can you possibly expect a Doctor/Nurse to hang around when there is so much to offer outside. My wife has been offered outrageous $$$$ to move to the states (Oncology aka Cancer). It just isn't realistic to expect what you guys are advocating. Another thing to note is yes the US has the biz in Germany (I have seen it first hand as a AO) But all those great Doctors and Nurses are for the most part Reservists. Guess what when you take from one to add to the other the civilian side looses out. But heck they only look after careless bricklayers

Captain J

The civilian system has exactly the same difficulty: too few doctors and nurses willing to work in substandard facilities, for too little money as part of an overly bureaucratic system.

The solution is simple: let the market do its work.  It cannot do any worse than the bureaucracy.

The law of supply and demand is absolutely immutable in any and all human endeavours.  Captain J's anecdotal evidence re: his wife proves that.  The major obstacle to an adequate health care system (I will not even wish for a first rate one) is Canadians' attitudes.  Canadians object to the reasonable sorts of salaries which a free market requires for health care professionals because Canadians are driven by greed and envy - they envy the high salaries earned by doctors and, simultaneously, they want 'free' health care from a large but lowly paid corps of medical professionals.  If hospitals and provinces and, yes, DND pay going market rates for medical professionals the shortages will disappear and the system will start to work better.  That isn't the only thing needed but it is the key to the shortage of doctors and nurses.  It's not going to happen any time soon because Canadians remain willfully ignorant of the facts of life.  (And anyone who thinks that supply and demand is not a fact of life is willfully ignorant.)

I fail to see what the fact that US military medical people are reservists has to do with anything.  Does that make their system inferior?  I don't think so.  Is the fact that many US reservists have been called to service creating the sorts of shortages in US hospitals which are the norm in Canada?  Of course not: the US civilian system, which obeys the law of  supply and demand to maintain its own, internal requirements can, quickly and easily, hire Canadian doctors and nurses.

Remember the other law, the one expressed by Pogo: "We have met the enemy and he is us."

We are our own worst enemy because accept a third rate national health care regime (down at the bottom of the list of OECD nations when either value or performance (outcomes) are measured) and then congratulate ourselves when the military system is only slightly less hapless.  That we do so indicates that we are second rate citizens.


Edit: structure - "The major obstacle to an adequate health care system ..."

 

[geo]

Geo said, "Where do you get the uninsured customers??? The CF and the RCMP are undiscounted full payment customers.  The Fed gov't pays for every intervention, tongue depressor, ear squib, cough drop, etc...... we are not a provincial charity case."

This phrase "undiscounted full payment customers" is catchy but from what government document did you draw it.  I suggest you read the following closely and see how soldiers are regarded under The Canada Health Act which states@ http://www.hc-sc.gc.ca/hcs-sss/medi-assur/res/gloss_e.html

"An insured person is interpreted under the Canada Health Act as a resident of a province or territory other than:

a member of the Canadian Forces;
a member of the Royal Canadian Mounted Police who is appointed to rank therein;
a person serving a term of imprisonment in a penitentiary as defined in the Penitentiary Act; or
a resident of the province or territory who has not completed such minimum period of residence or waiting period, not exceeding three months, as may be required by the province or territory for eligibility for or entitlement to insured health services."

Therefore, we have the Canadian Forces Spectrum of Care http://www.forces.gc.ca/health/services/engraph/spectrum_of_care_home_e.asp?Lev1=1&Lev2=5

1. The Canadian Forces Spectrum of Care (SOC) document was first published on 21 December 1998 to describe the health care benefits and services, medical and dental, that are available and publicly funded for members of the CF and other eligible persons. The SOC is published by the Director General Health Services under the authority of CMP and it is updated regularly.
2. The document provides direction to CF health care providers, Health Care Coordinators (Base/Wing Surgeons) and Dental Detachment Commanders. It also authorizes the utilization of public funds to ensure that CF members have access to a comparable standard of health services as Canadians receive under provincial health care plans.

Gunner, To be honest, I do not see any disparity between what I said and what  you have brought up.  I concurr, members of the CF on active service (Reg & Res Cl C & B +180 days) are covered under the the CF SOC.  Where the CF does not have facilities, health care standards will be provided at public expense..... IE - the CF / DND / Federal Gov't foots the bill - usually thru their intermediary - Blue cross.... ERGO, we are not charity cases, we are not a financial burden on provincial gov't health care services, we bring them additional hard cash $$$ that they would not be receiving otherwise.

 

[Gunner98]

Geo says,"To be honest, I do not see any disparity between what I said and what  you have brought up...we are not a financial burden on provincial gov't health care services, we bring them additional hard cash $$$ that they would not be receiving otherwise." 

The CF Health System is separate from and dependent on the civilian one.   I agree we are  not a financial burden, we are surplus to the capacity for which the system is organized in accordance with their funding models.  In a system that has a long waiting lists and an abundance of injured, dying people, we are not the always the first priority for the health care provider that we would like to think we are.   This is not always in the best interest of the individual. Many soldiers assume the entitlement to a faster, equal level of service and that the provincially funded hospitals are not mandated to provide it. The additional hard cash sounds good in principle, the fact is that there are only so many beds and procedures to go around, and many are full with long waiting lines.
 
Veterans Affairs has different treatment benefits for injured soldiers based on being injured in "Special Duty Area", these are greater than what the regular soldier is entitled to.  These are discussed @ http://www.vac-acc.gc.ca/clients/sub.cfm?source=services/vip/vachealthvip#2.

In both cases CF SOC and VA benefits must be pre-approved for payment, this is part of the separate system's control mechanisms.

 

[geo]

......... Concurr that most hospitals have done things like closing wards to cut costs.  They are staffed for the Civ population and the arrival of VERY seriously injured soldiers might place a burden on facilities in regional health centres (hospitals in major centres should be able to cope).  From what I have experienced, hospital emergency rooms and clinics (outpatient) are the ones that are being pushed beyond their capacity - Our soldiers having received their ER care prior to arrival should ease the burden somewhat.

WRT procedures and waiting lists, most provinces have placed limits to the number of procedures that a single Dr can do in his working schedule.  Many Drs work in "for pay" clinics after completing their shifts - there is additional capacity in the hospitals - regardles of what provincial authorities declare.

 

[observor 69]

Response to Edward Campbell, Coming Home for TLC, today 0845:

  I am a firm supporter of Canada's National health care system and universal access.  All Canadians should have access to the best care possible. Unfortunately we now have the technology to keep you going forever, drugs and technology cost many dollars.  I agree our health care system is suffering from many problems but a reading of the many studies that have been carried out, most recently the Romanow Report, describes a system delivering a level of health care above the average of OECD countries.
  By any measure our national system of public health care is vastly superior to the US private system. Check out the OECD stats again to prove this. Health care and education are two of the most important services provided by government and should not be left to the pressures of the market place.

Ref: http://www.hc-sc.gc.ca/english/care/romanow/hcc0086.html
      http://www.oecd.org/dataoecd/19/13/36956887.pdf

 

[Bruce Monkhouse]

our health care system is suffering from many problems but a reading of the many studies that have been carried out, most recently the Romanow Report, describes a system delivering a level of health care above the average of OECD countries.
  By any measure our national system of public health care is vastly superior to the US private system. Check out the OECD stats again to prove this. Health care and education are two of the most important services provided by government and should not be left to the pressures of the market place.

Ref: http://www.hc-sc.gc.ca/english/care/romanow/hcc0086.html
      http://www.oecd.org/dataoecd/19/13/36956887.pdf

MOD REQUEST
If one wishes to respond to this than do so in the appropriate thread, and its not this one.

Baden Guy,
Keep it on the topic and comparing our health care systems is not it.

 

[GO!!!]

Gunner 98,

To summarize,

1) We, as soldiers, when injured, become "cash paying" customers of the civilian HC system, once the acute care phase is completed by military HC resources.

2) We are not realistically entitled to any special care beyond what a civilian would recieve.

3) The civilian HC system has flaws, which are well documented and acknowleged, especially concerning capacity.

4) Our allies (US) run excellent hospitals (albeit in other countries) that specialise in military injuries, and can be described as having, at present, "excess capacity", which they do not object to us using, as CF pers are a part of it.

5) The CF is obligated to provide injured servicemen with the best care available.

Could a strong case not be made to leave service members in US military hospitals, given that the CF is paying anyway - does it matter who it is paying, especially since there are long waiting lists domestically?

Am I being unreasonably cynical when I assume that the CF's rush to repatriate injured men is based more in the likelihood that our civilian system is far cheaper than the US military one - and cost is the driving concern, rather than a burning desire to see soldiers reunited with loved ones in specific geographical locations?

 

[armyvern]

Am I being unreasonably cynical when I assume that the CF's rush to repatriate injured men is based more in the likelihood that our civilian system is far cheaper than the US military one - and cost is the driving concern, rather than a burning desire to see soldiers reunited with loved ones in specific geographical locations?

Good points GO!!! But I've got to tell you that I have absolutely ZERO problems with the CF repatriating our seriously injured back to Canada and their local areas, regardless of cost. I would hope, that even if it happened to cost 10X as much to bring them back home as opposed to them remaining in-theatre or Germany, that the cost factor would be the last thing on the CFs mind, and that the healing and welfare of the soldier and his/her family would come as the first and foremost priority. As I have a feeling it is.

 

[the 48th regulator]

GO!!!


My sentiments are with your argument, however, does it not tax the U.S in caring for us?

Their mission is to care for frontline injuries, and then stabilize us to be able to return home.  Injuries suffered from there should be taken care of, by our medical personnel.  However, we have diminished that (no thanks to our previous government) and closed down medical centers.  Contrary to many of the posts I have read, NDMC was phenomenal in the care of me.  We closed that down, and I am sure our civilian medical system should be capable of taking care of us....however, are they?  That is what I agree with you.

It is about time we start to get our military medical side beefed up, much like the combat side of things.

CDS, are you reading this thread?

dileas

tess

 

[geo]

From personal experience dealing with people who are on the receiving end of Health care services, they are always better off being either back home OR as close as possible to family and friends.  If DND/CF/Fed Gov't has to cough up a little bit of extra change to the provinces for the extra demand on capacity - so be it.

Whle rural/regional Health centres are not exposed to daily incidents of major trauma from Gunshots, IEDs, VBIEDs, etc - hospitals in the major centres are.  I think the provincial health care system is fairly well equipped to care for our wounded soldiers.

There was a thread last fall about the UK doing something similar - sending wounded troops to civ hospitals near family & friends (even if, in their case, there was the added bonus of a surly hospital employee to deal with)

 

[observor 69]

MOD REQUEST
If one wishes to respond to this than do so in the appropriate thread, and its not this one.

Baden Guy,
Keep it on the topic and comparing our health care systems is not it.

Agreed I failed to show the connection to the ongoing topic. The point I was trying to make is that I have reservations on this new announcement of sending wounded servicemembers to hospitals across the country. While I highly respect our national efforts to provide universal health care across the country there is a distinct difference in the level of care available in the have and have not provinces. The nature of the injuries resulting from IEDs, brain trauma for example, I feel would be best treated in the major centres such as Sunnybrook.
Hopefully our medical  personnel are aware of this challenge.

 

[geo]

GB,
Am certain that the CF will not dispatch personnel to Civ Health care facilities without 1st ensuring that the centre is equipped and capable of handling treatment.  If a good centre has to be 500 Km from home, then the one with limited resources 20 Km won't do & should not be used.
At least that's what I have seen, to date, with LFQA returnees.

 

[Gunner98]

In response to GO's question, "Could a strong case not be made to leave service members in US military hospitals, given that the CF is paying anyway - does it matter who it is paying, especially since there are long waiting lists domestically?"

The interesting element in military combat medicine is the concept of proximity:
- If the soldier is likely to return to combat keep them as close as possible to combat. 
- If the patient must be evacuated for additional treatment is he likely coming back to combat or
- Does he need an extended period for recuperation.
- Should he be evacuated to a treatment facility close to home, as soon as possible.
- When can he be stabilized for transport.

Please take a look at the Landstuhl Regional Medical Centre (LMRC) facts below as listed @ http://www.landstuhl.healthcare.hqusareur.army.mil/resources/lrmcfacts.aspx  I think you will agree that LMRC has a capacity issue as well, based solely on the average of 16 admissions, 17 operations daily each day and only 162 beds.  On average each bed must be vacated every 10 days. I think you will agree that LMRC has a capacity issue as well.

LMRC is used because it "is the only Army medical facility to house an Air Force Aero-medical Evacuation Unit."

LRMC Facts
Location - Landstuhl Post is a permanent U.S. Military installation located in the German State of Rheinland-Pfalz, 11 kilometers west of Kaiserslautern and 5K south of Ramstein Air Base.

Population Served - LRMC is the largest American hospital outside of the United States, and the only American tertiary hospital in Europe. We provide primary and tertiary care, hospitalization, and treatment for more than 52,000 American military personnel and their families within the center’s boundaries. The center also provides specialized care for the more than 250,000 additional American military personnel and their families in the European Theater.

Specialties Unique to the European Theater - Hematology/Oncology, Pediatric Cardiology, Rheumatology, Burn Stabilization, Neurosurgery, Nuclear Medicine, Addiction Treatment Facility, Neonatal Intensive Care, and Magnetic Resonance Imaging, (which is not limited to extremities).

Staffing - The military staff of the hospital is 50% Army, 15% Air Force, and 35% Civilian. There are also two Navy personnel who serve as liaisons when U.S. Navy and Marine Corps personnel are here for treatment. The Veteran's Affairs staff is on site to respond to benefits requests and needs. The hospital has approximately 110 physicians, 250 nurses, 40 Medical Service Corps officers, 900 enlisted personnel, and 550 civilian employees. The Landstuhl military community is the only Army medical facility to house an Air Force Aero-medical Evacuation Unit.

Statistics - There are 162 beds and neonatal bassinets at LRMC, with an expansion capability in excess of 310 beds. There are, on the average, 16 admissions daily, 37,000 outpatient visits monthly, 510 operations monthly, and 3 births daily.