Solving the health care crisis, Part 2

Hey there, time traveller!
This article was published 18/06/2024 (552 days ago), so information in it may no longer be current.

A story from more than 10 years ago illustrates a core weakness in our approach to health care.

On a winter pilgrimage to Puerto Vallarta some 10 years ago, my wife experienced a severe stomach ailment. We visited a local emergency room at 9 a.m., which incidentally clearly served locals and tourists. She saw a physician at 10, who ordered blood tests completed at noon and told us to return to our hotel to wait for an email.

It turned up at 4 p.m. and included a complete analysis showing which results fell within the normal range and one that was clearly out of bounds. Included in the report was a recommended medication, which we filled by 5 p.m. By the following morning, my wife was recovering well, less than 24 hours after the initial visit to the emergency room.

It is not the speed of response that struck me as remarkable, although I expect it was faster than we would have experienced in Manitoba; instead, it was that the Mexican doctor trusted us with a detailed report that included a recommended action.

I have never seen my complete medical history in all my significant interactions with the health system in Manitoba, and that includes two hip replacements and major cancer surgery. Sharing medical information is fundamental to increasing patient self-reliance. However, these data are of little benefit without the skills to interpret the results.

That is why we need doctors. Or do we?

Recent advances in artificial intelligence (AI) diagnostics are startling. In early 2023, many clinicians spoke derisively about how AI often got diagnoses wrong. In the March 2024 issue of Artificial Intelligence in Medicine, the authors of a review on AI in medical diagnosis now write, “… the objective is not to replace the human decision-makers with AI; it is to produce accurate algorithmic predictions, which are then supplemented with the (value) judgments by human experts.” At this rate, I expect the March 2025 issue of the same journal to report that AI performs medical diagnoses that are superior to those offered by doctors in the same way that computers now routinely defeat humans at chess.

My annual checkup has always featured doctors riffling through file folders and, more recently, peering at electronic medical records on screen. Imagine an app on my phone that stores my medical information, specifies, and schedules routine tests, and refers me to specialists as needed. The demand for doctors’ time in routine visits plummets, and “poof,” the doctor shortage disappears. Physicians can focus on more critical tasks.

While I am convinced that sharing detailed medical information and AI diagnosis will transpire, let us be cautious. First, the government has a miserable record of creating information systems. I have more confidence in private firms to create and manage these systems.

Second, the medical profession is very diligent in protecting its turf. It will not relinquish its monopoly on information and diagnosis.

Third, and most importantly, many patients have neither the inclination nor the ability to manage their health and want an empathetic human, especially when dealing with challenging health conditions. However, after a few years, most will value the convenience and immediacy of having all their medical data in a phone app and an AI assistant to guide their medical care.

This brings us to the privatization of health and the family. Family carers (including friends) have always been essential to our health-care system, whether driving patients to appointments or managing them post-operatively. According to the 2018 General Social Survey by Statistics Canada, almost eight million adults cared for a family member, most commonly parents and parents-in-law. This number will undoubtedly grow as boomers enter advanced old age.

Manitoba has about 10,000 personal care beds in about 125 facilities. The government plans to add another 1,000 next year to meet the needs of the aging baby boom. Based on changes in population projections, we will need at least another 4,000 beds to meet the demand over the next five years, and one evident approach is to accelerate the construction of more personal care homes. But this could be a mistake.

Right behind the baby boom is a baby bust. This means the increase in the number of seniors over 70 will slow sharply by 2030, and we could build too many facilities. Personal care homes are not static facilities where people reside for extended periods — they more closely resemble revolving doors with average stays of a couple of years.

An intelligent policy might be to increase financial and logistical support to family caregivers to keep seniors in their own homes for as long as possible. Increased medical deductions to reduce tax burdens and the ability to withdraw from pensions with reduced tax penalties are ways to do this.

Solving the health-care riddle will require novel approaches. The tried methods are no longer valid, and the real question remains … will governments and Manitobans be willing to take a new direction?

Gregory Mason is an associate professor of economics at the University of Manitoba.