When I spoke recently with an amputee, asking him if there was any subject about which he as an amputee would like more information, his response was, "Anything that doesn't put me to sleep." A subject that rarely puts anyone to sleep is, "How much is it going to cost me?" So, I am taking the liberty to write about money matters. By way of history, when I first started working in Edmonton in 1980, the Alberta Aids to Daily Living (AADL) Program was in its infancy. The program was created by Premier Peter Lougheed to provide "all ambulatory needs to all Albertans." Yes, the program was created foremost to meet ambulatory needs, especially wheelchairs, artificial limbs and braces. It has since grown to include oxygen, surgical supplies, hearing aids, bath equipment, beds and lifts, incontinence supplies, catheters, and a myriad of other items.
Today, after having been switched out of Alberta Health & Wellness and into Alberta Seniors & Community Supports, with the assurance that the move was strictly administrative and that there would be no change to the delivery of Prosthetics & Orthotics (P&O), it seems that much has changed. The P&O portion of the $80 million (2006) budget is a mere $10 million. The number of providers is restricted to "preferred vendor status," while the choice of product and services for amputees has been capped. What was once a "needs based" program has become an "eligibility based" program with quantity limits and "set price" maximums [AADL Program, General Program Information, August 2004]. AADL claims it can no longer fund anything more than "basic" items, yet has involved itself in funding myo-electric components (for example a myoelectric elbow, in excess of $10,000) and Schedule Y studies to the tune of $100,000. The program is spread so thin that items which have been clinically proven to improve the comfort of the amputee (particularly gel liners) are now being scrutinized as "too expensive for the program to sustain" and their removal is being considered. This sounds to me like "managed care" which, twenty years ago, had its run in another country not too far from our own. It is the same country which today is advancing patient care through parity legislation. Parity legislation ensures that patients have a choice, of practitioner and provides that the insurer, if it commits to covering prosthetics and orthotics, does so with no limits to the components and services that may be provided to amputees. Wrapped up in all of this is a commitment by the P&O industry that its members will acquire advanced education. This has been spearheaded by the Amputee Coalition of America, working in conjunction with a number of stakeholders. This sounds amazingly like what we once had here in Alberta, doesn't it?
Wait a minute. I said I would write about money matters. With the announcement by the Stelmach administration that health care premiums will be eliminated, does it bother you that what is not on the table is the elimination of the mandatory $500 annual deductible that each individual requiring P&O services is forced to pay? This is an even smaller amount of the total health care premiums collected by the government, yet it remains. This "tax" is being levied against those who are most likely to have immediate income loss for several or more months. I would venture to say the income loss for many will not be picked up again throughout their lives.
Similar to other medically required services, the investment on the insurance side ought to be to address the need for prosthetic and orthotic coverage today, so that one has the best chance of a brighter tomorrow. Having the prosthetist or orthotist impose a 10 percent surcharge on products and services to make up for the government's shortfall in funding is not the answer this province of plenty should be seeking. Increasing the P&O budget is what we should be seeking. Amputees need to speak with a loud voice to ensure adequate funding continues.
We have been promised change by this government-change that is to occur in the near future. Let's hope it leaves change in your pockets and provides the peace of mind to know that our tax dollars are well spent investing in you, rather than in levels of administration.