Taylor Swift just completed the Canadian leg of her tour in Toronto. There were about 50,000 Swiftees there. Sixty dollars for an official Taylor Swift sweatshirt. Two thousand three hunded dollars for the cheapest ticket on resale platform StubHub. All the Swiftees could buy some grub. Get seated. Go to the WC. Be somewhat protected. The concert demonstrated what can done by adding capacity to handle large numbers of attendees.

 

This contrasts with our healthcare system where growth in capacity has been limited by design. 

 

Dr Brian Day of the Cambie clinic was on our podcast at Healtheon.ca  a few weeks ago. He explained very clearly how a long term plan was put in place by health system planners to limit any growth in healthcare capacity.

 

The logic is simiple. Fewer MRI machines, less funding for MRI studies. Fewer operating rooms. Lower costs for surgeries. Fewer medical doctors. Less funding for doctor’s services.

But this as a long term strategy seems to have lead to an erosion of timely services.

 

An Engineering Approach To Adding New Healthcare Capacity:

 

Large projects such as electricity generating plants are designed by engineering groups.

Many of these large projects as structured as Build Own Operate Transfer ( BOOT) projects. 

The private sector funds the project including design and construction. The private sector operates the plant. The output is sold based on a long term purchase contract with the government. The contract makes the addition of new capacity rational. Eventually, the ownership of the project is transferred to the government. 

 

The BOOT approach is being used in healthcare in Canada  and could be expanded to include many types of healthcare capacity. 

 

The Use of AI To Increase Workforce Capacity:

 

There is a need for more doctors, nurses and nurse practitioners. The addition of new workforce capacity takes generations. 

 

There is a very innovative approach to adding workforce capacity. AI doctors and AI nurses are appearing. These bots are based on extensive testing. They have access to vast amounts of data. They can be engineerred to be empathetic. When listening to a nurse bot talk with a patient.,one can not tell the difference between a nurse bot and a real nurse.

 

The economics are intersting. A nurse bot can be rented by a hospital for $9 per hour. That is a dramatic savings for the hospital. And testing shows the nurse bot to be more accirate than a real nurse. 

 

Let’s Look At Australia’s Pivot In Building New Capacity:

 

Medibank was the first iteration of medicare in Australia. It was introduced in 1975. There had been a public debate on the idea of a private health inisurance scheme from 1967. Australia had universal health insurance. It guaranteed all Australians access to a wife range of healthcare services at low or no cost. The government recognized the need for more healthcare capacity. Accordingly, the government started Medibank as a not for profit  private healthcare insurer owned by the government of Australia. This plan worked. And now there are 4.2 million Australians covered by Medibank. And funds from premiums were used to fund services and to pay for new capacity. 

 

Conclusion: 

 

Creative strategies can be used to increase capacity in healthcare. We have discussed how the BOOT model from engineering can be applied in healthcare. We have illustrated how AI enabled bots ( nurses) can be immediately introduced to patients at a dramatic reduction in cost. And we have demonstrated the example of private not for profit health insurance in Australia that facilitated the growth of new healthcare capacity.