If you think wait times at Toronto hospitals are already too long, just wait until 2036.Twenty-five years from now, Toronto is expected to have one million new residents. It’s projected the GTA will reach 9.2 million by 2036, a 44 per cent increase from 2011.
Density is rapidly increasing to well above the old city average of 4,077 people per square kilometre, a trend expected to continue to intensify in coming decades.
The city’s health-care services, particularly hospitals, are already plagued by long wait times and stretched resources. The average current wait time in a Toronto emergency room is about eight hours.
So what needs to happen to keep quality health care from taking a dive?
It’s a question that must be addressed if the province is to prepare for the coming growth in Canada’s biggest city.
Dr. Tarek Sardana, president of Orleans Urgent Care in suburban Ottawa, said health-care delivery in high-density urban cores like Toronto could benefit from facilities similar to the one he leads. He describes it as a walk-in clinic on steroids.
Since opening in 1994, at a time when hospitals were facing budget cuts and ER-trained staff were losing their jobs, the Orleans clinics, staffed with emergency-experienced staff, have seen 60,000 patient visits on average annually.
“We fill a niche between the hospital, big-city stuff, and the family doctor,” Sardana said, adding that most of the costs of a visit there are covered under OHIP. “Urgent care, if done properly and not affiliated with a public facility — because costs go up — in the right spots, where there are crowded emergency departments and difficulty accessing care, they could fill the gap.”
The cost of seeing a single patient, who is typically treated and out the door within a few hours, is minimal next to the single-patient cost at a hospital.
Sardana said the average is about $12 per patient, compared with roughly $180 at a hospital.
“We’re the most efficient health-care delivery system in the province,” he said. “We prevent about 15,000 (patients) annually from going to the emergency room. They’re treated and out the door.”
Not only do urgent-care clinics alleviate stress on overworked, understaffed hospitals struggling to reduce wait times, they reduce the costs of delivering care, Sardana said.
Urgent care centres aren’t nearly as common in Canada as they are in the United States. Since the late 1990s, the number of such clinics south of the border has grown to nearly 9,000, according to a 2011 report from the Urgent Care Association of America.
Available in high-density cities like New York, Boston and Miami, and smaller cities like Topeka, Kan., and Gastonia, N.C., urgent-care centres can operate successfully based on population needs.
Mississauga, Brampton and Vaughan all have urgent-care clinics. Only one exists in Toronto, in Etobicoke.
While the Orleans clinic carries a full staff, Sardana said it isn’t easy to find physicians and nurses experienced in emergency-room care willing to work in urgent care — one reason, he believes, they’re not more common in Canada.
While the pay is still good, it isn’t comparable to hospital salaries. So drawing staff to these private-style clinics can be difficult.
Dr. Lawrence Frank, one of North America’s leading experts on urban planning and health, agrees that Ontario could benefit from having more urgent-care clinics to reduce strain on hospitals and provide faster access.
But more efficient care delivery isn’t the only thing that could alleviate the burdens on the system.
Given its increasing population and a shift to an older population (by 2031, the city’s population will include nearly 500,000 seniors, compared with just over 300,000 in 2011), Toronto needs to consider how it can promote healthier, more active lifestyles.
“There is evidence to suggest (seniors’) overall chronic disease onset rates would be less because they’re more active,” Frank said. “The quality of life is the metric. If they are staying (healthier) longer, then that should save us money in the long run.”
Sure, healthier residents will lead to less use of the health-care system. But medical professionals say the reality is that the system also needs to grow.
More than 70 community health centres now exist across the province, offering access to primary health care through doctors, nurse practitioners, dietitians and other services — again, limiting the need to rely on hospitals.
A study released in March by the Association of Ontario Health Centres found that patients who took advantage of community health centres used a hospital 21 per cent less than patients who received their care elsewhere.
“The need is for us to be working upstream so we’re preventing illness,” said Scott Wolfe, federal coordinator for the Canadian Association of Community Health Centres. “Urgent care becomes much more essential when we’re not preventing illness.”
Conservatively, Toronto would need an extra 80 such centres to effectively accommodate the city’s needs — one centre per 30,000 people, he said, based on current population numbers.
Wolfe currently travels 45 minutes north of the city when he needs to see his family physician. While the service is great, he said, in such situations there is no connection between the doctor and the community the patient lives in.
“Community health centres excel in being attuned to people’s lived realities,” he said. “When you make a visit to get your health care, that physician or dietitian has a sense of what’s going on in the community. They understand there may be a real lack of access to quality foods; they can actually look to the root causes.”
Instead of just seeking to expand health services, we need to look from within the system at what has already proved successful, Wolfe said.
“It’s more cost-effective care,” he said. “We need to do a much better job with models of care and places of accessing care within the system that already have demonstrated some of the burdens that we’re potentially looking at urgent care clinics to take care of.”
Original Article
Source: the star
Author: Andrew Livingstone
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