Friday, September 9, 2011

What we don't know...

I am in the 'real world' a health economist, who makes a living by supplying information to decision makers about the health care system. I work for the organization that has the responsibility for ensuring that quality, appropriate, cost effective and timely health services are available to all British Columbians. Granted, it's a hefty mandate and there are real and significant challenges to meeting it - an aging population, the rising incidence of chronic disease, technological advancement, human resource limitations, and funding limitations.

Having experienced an aspect of the health care system in BC - I am troubled. From my perspective the system 'failed' to delivery quality, appropriate, cost-effective and timely health services. What's worse, is that I know that from the system's perspective there is no way for the system to know that it has failed because it does not collect the kind of information it would need to in order to come to that conclusion. My experience does not 'show up' statistically...and that is problematic - because if my experience does not matter (in a statistical sense) then all of the women who have a similar experience also don't matter (in a statistical sense). Worse - how do we get to a better system that actually delivers what it is supposed to (quality, appropriate, cost-effective and timely health services) if we are not brave enough to collect the information that would actually enable an accurate and meaningful assessment of system performance?

So what do we not know, that we need to know (with respect to maternity care)?
1. We need to know how many women actually deliver their babies in the way that they and their doctors or care providers planned to deliver their babies.
2. We need to know how many women actually receive elective c-sections on the date that they planned to receive the c-sections.
3. We need to know if women are satisfied with the care they recieved - and if they aren't we need to know why.
4. We need to know how many women want to recieve epidural anaesthesia, how long they wait, and if they can't get it, we need to know why.
5. We need better information on rates of post partum depression (PPD) and post-natal post-traumatic stress disorder (PN PTSD).
6. We need better information on delays to accessing c-sections when they are deemed neccessary - near misses and the reasons for them need to be known.

What we know right now, what show's up statistically - just isn't good enough...

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