Wednesday November 26, 2014

Living Well


The ethics and moral hazard of redistributing medicare resources from crisis management and palliation to prevention, regeneration and enhancement is a very interesting wellness issue to discuss. Let’s use joint health comparing joint replacement with regeneration as an example. (
We currently do over 2,200 crisis stage knee replacements annually in Saskatchewan. Let’s use the Alberta fair market value of $18,000 to determine the resources utilized for this procedure. The question is, should an alternative procedure of injecting stem cells gathered by liposuction of belly fat be available at a book value of resources utilized of $4,000 or less, and should the number of procedures be limited to 10,000 so that the budget allocation be unchanged, or should it be different and why?

When policy makers are faced with the decision of how to ration  high-cost procedures, they design “qualifying criteria” to match procedures with available health care resources.  

In our example of “joints”,  the economic consideration is that persons receiving the lower cost early stage procedures are more likely to be younger and still be tax-paying wage earners, as opposed to our current situation where criteria put off the procedure until the majority of those receiving treatment have a  more degenerated joint and are more likely to be older, retired and unemployed disabled persons.

The moral hazard to the medicare policy makers is that there is an immediate payback to the taxpayer as each regenerative  medicare dollar consumed by a higher tax bracket taxpayer generates revenue to fund late stage crisis and palliative cases. The ethics of rationing services vs. best quality practice is customarily allocated by sieving access using a mathematical construct called the QALY (quality adjusted life year). In Saskatchewan we have an organization called the Health Quality Council that meets annually to bring all players together  discuss this and other TQM (total quality management) issues.

I attended the 2014 event on May 7 in Saskatoon with the intent of engaging in a dialogue with this group. Is it ethical to reward the individual who contributes to the pre-treatment preventative and post-treatment situations such that outcomes are anticipated to be better than what is considered average is one question to pose. Should individually designed and funded experimental inputs from patients to enhance the wellness outcomes be critically scrutinized or should they be actively encouraged and supported when  there is a potential benefit to the health care system so that medicare can learn how individuals who undertake these “off-label” health management measures fare and facilitate the sharing of these experiences between patients and the general public.  

In my example of “joints”, many factors contribute to joint degeneration. Weight combined with patterns of physical activity minus  preventative measures generates net physical stress.

A silent inflammatory process also reduces the efficiency of joint repair processes then amplifies the degenerative process. A micro-biome or complex film made up of a community of microbes populates joints and contributes to both wellness and degeneration depending upon the species profile inhabiting the joints over decades. Diet plays a huge preventative role, with curcumin from turmeric, ginger, hops and resveratrol limiting inflammation from both physical stress and sub-clinical infection. So there are many ways to interact with the degenerative process and enhance the wellness potential of the outcome.

The idea is to enhance medicare by distributing new knowledge (such as taking and converting it straight from leading edge experimental to a cheap generic medicare-P3 delivered therapy) to the general public, so medicare begins to embody “Moore’s Law” of  “faster, better cheaper” as individuals empower themselves to  live ever longer and healthier lives.


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