In the current debate about rising health care costs there is a commonly heard suggestion that we need to “bend the cost curve” of health care. My fear is that this bend is going to happen on the backs of the already lowest-paid workers in the sector (think PSWs and home care staff, for example).
Many of the strategies underway and coming are long overdue:
- Optimize the scope of practice of all of the health care professionals in the system;
- Instill more rigour in the measurement of institutional performance;
- Apply lean techniques and strategies in the health care sector;
- Review compensation and incentive plans for our health care providers;
- Encourage the use of lower cost alternatives to hospital care;
- Encourage patients to share responsibility for their health and their care.
All of these strategies make sense.
But a caution … Community-based agencies and providers, who have for decades been quietly providing solid, high quality care, can’t be squeezed any further. We can’t and shouldn’t be asking them to do more with budgets and pay scales that are already far less than their hospital-based counterparts. Sure, they don’t have the overhead. But we are asking them to provide more complex care, to more patients. We are asking them to meet new and demanding contractual arrangements with no recognition of the cost. We are pressing them to use their volunteers to provide services that we might otherwise have to pay for.
We’ll bend the cost curve, possibly. And we’ll bend it so far that we will be able to brag that we are looking after patients using the most demoralized, poorly paid, burnt-out health care workers anywhere.