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Communit Dis-eased

Leigh MacKay OP Contributor

Among the provincial legisla- ture’s goals is a balanced budget

beginning in 2004/05. It is an

admirable goal. However, I can’t help but feel that some members of government are so fixated on this, they're dancing like kids waiting to get into a crowded washroom.

Campbell’s cost-cutting crew craves fiscal responsibility, and this strongly held desire touches the arm of every government- supported agency. Heath care, a rather large arm, is receiving an equally large share of budgetary attention. To healthcare providers, the proposed reduc- tions are painful and, in some cases, life threatening.

BC's laboratory system is a tar- get in Victoria's sights. Pathology laboratory services are an impor- tant component of patient care. These services are frequently your physician’s first tool in pro- viding a correct diagnosis. He or she fills out a slip using that funky handwriting physicians are trained in, and you go to a labs Patient

Barbara K. Adamski

patient care. I'll buy that. But in the same way that the symbol of medicine features two serpents on a staff, Colin’s other first pri- ority is to trim the health care budget. Joe and Jane taxpayer/healthcare user have two points of view to consider. Which one is seeing more clear-

ly?

The Labs’ Point of View

For more than 45 years, commu- nity labs have been providing quality, cost-effective laboratory services. This point is a big one. Physicians base 70-80 percent of patient care options on the results of laboratory testing, so the laboratory system is a vital element of patient care.

The best-known community labs in BC are MDS Metro, BC Biomedical Laboratories Ltd., and Valley Labs. Every day in BC, the 1,600 people working in these community labs:

* provide tests from a selection of more than 500 different tests,

Some members of government

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Healthcare Laboratories y Victoria’s Plans

their homes and in long-term care facilities, at no charge to the patient or health care system;

¢ deliver more than 5,000 speci- mens to public testing agencies such as the BC Centre for Disease Control and BC Cancer Agency, again at no cost to the patient, agency, or health care system;

* transmit lab results electroni- cally via PathNET to more than 3,000 physicians, and support services through an extensive network of collection, trans- portation, information technolo- gy, and analytical expertise that has taken many years to develop.

What the Labs See Happening The budget benders will take the funds for laboratory services out of the Medical Services Plan and transfer them to hospi- tal programs where the funds’ management will come from a new bureaucracy—the Provincial Laboratory Coordinating Office (PLCO).

The legislature has announced a 20 percent cut in the fees it pays to labs for the testing serv- ices. (An 8 percent cut took effect on September 1, 2003, and a further 12 percent cut will take effect on April 1, 2004.)

The government is going to dismantle the existing province- wide system and create six inde- pendent lab delivery systems— one within each of the health authorities. The PLCO will manage this transition.

(This next one is interesting.) Victoria sees an open bidding process that would have

Centre in your neigh- s ; each health bouthood, where you gre so fixated on this, they're ery pee into a bottle or to tender for ae cteeeermaw dancing like kids waiting to (nasrainy somethin reall ° inpatient) lab crabassscstal oe get into a crowded washr oom cite This

another type of con- tainer. This stuff, which once was in you, goes off to the lab for testing by highly trained people who know what to look for and are not squeamish about looking for it. When they're done, a report goes back to your physi- cian.

Minister of Health Services, Colin Hansen, says that his department's first priority is

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from routine to specialty diag- nostics;

* perform more than 55,000 tests on the 16,000 patients who visit one of the labs somewhere in BC;

* support early discharge hospital programs by providing access to lab testing at home and in the community;

* visit more than 700 patients in

http://www.-otherpress.ca

process is to be completed by October 2005, and will also be coordinated by the PLCO. (The PLCO has recently indicated it intends to complete the framework for a formal Request for Proposal by December 2003, with the final RFP ready by April 2004.) Fee cuts of this magnitude will have a significant effect on patient access to laboratory services in

BC:

Our government's other plans are even more concerning, and will bring an extended period of instability as today’s system is turned upside This includes the creation of six frag- systems—potentially providing six levels of service and access—and six new bureaucra- cies to manage them. (Where does the money for this come from?)

down.

mented

How Victoria Sees It

I emailed a few questions to my MLA, and received a prompt reply. It looks like a boilerplate document, which doesn’t really matter. What it has to say, though, does:

We currently have more than

BC taxpayers pay $25 more for lab services than Ontario taxpayers. What could account for

the discrepancy?

27 lab information systems oper- ating in isolation from each other. This disjointed approach means test results aren't available across the system, tests are unnecessarily duplicated, and care providers face missed oppor- tunities to provide better, more informed care for patients.

BC taxpayers currently pay 50 percent more than the national average for lab services. BC’s lab expenditures are approximately $115 per capita per year com- pared with a $77 per capita national average and $90 per capita in Ontario, the next most generous province. That’s why we are reducing lab fees and rein- vesting $35 million back in to the lab system so we can develop a more coordinated information system that better serves the peo- ple of BC.

Contrary to what some physi- cians suggest, the money saved does not belong to labs and doc- tors—it belongs to patients and it will be going directly back into the healthcare system to enhance patient services.

We have established an inde- pendent office to develop this

November 19, 2003

process—the Provincial Laboratory Coordinating Office (<www.plco.ca>). I encourage you to visit their website for the latest information on the lab reform process. We recognize that private lab providers are an important part of our current network and we encourage them to work with the PLCO to create a stronger lab system for all British Columbians.

So Who's Right

Both parties agree that lab work is essential. Lower Mainland labs are in place with all the right equipment and trained person- nel.

The province says there are more than 27 lab information systems operating in isolation from each other. The labs say they communicate to more than 3,000 physi- cians via PathNET. I sus- pect it is an apples/oranges situation. The province is talking about the province as a whole. The labs are talk- ing about the lower mainland. Can all the systems be linked? Do computers have boards?

What is the creation and

operation of the Provincial Laboratory Coordinating Office going to cost taxpayers? Where is the money for the office coming from? Victoria is cutting $35 million from the lab services budget and putting it back into the lab services budget after fil- tering it through the kidney of PLCO.

BC taxpayers pay $25 more for lab services than Ontario taxpay- ers. What could account for the discrepancy?

And what about this open bid- ding process that would have each health authority go to ten- der for all outpatient (and possi- bly inpatient) lab services? Everyone agrees on the impor- tance of lab work. The province wants the ability to opt for Kut Korners labs to provide our physicians with their key diag- nostic information. How long before expensive mistakes start happening? Is it safe to load the back of the system with another level of bureaucracy and then shave meat off the legs? How long will it take before the thing collapses on itself? My stopwatch is running.

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