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Letter: Government’s flu shot decision ill-conceived

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Physicians in the province are concerned that, if a new government plan goes ahead, fewer people will get the flu shot and more cases of influenza will occur during the next flu season.

Health Minister Dr. John Haggie recently announced that MCP will no longer pay doctors to administer flu shots. Yet family doctors have been providing around half of the 125,000 flu shots administered in Newfoundland and Labrador. Physicians provide flu shots in two ways. About 33,000 flu shots are provided for a professional fee charged to MCP during dedicated flu shot appointments, and another 33,000 are provided at no additional charge as part of office appointments where other patient issues are diagnosed and treated. Under the minister’s plan, fee-for-service family doctors would only be permitted to provide flu shots as part of office visits, at no charge, but it is uncertain how many doctors will continue to provide this service.

The minister’s plan is an arbitrary, one-size-fits-all intervention in a family doctor’s approach to comprehensive and preventative health care. It was done without consultation with physicians or the 65,000 people who use physicians for this important service.

Each year, family doctors administer flu shots to some of our most vulnerable at-risk patients. This includes the frail elderly, young children, pregnant women and those with chronic health conditions like respiratory illnesses.

During the 2015-2016 flu season, there were 218 hospitalizations, 49 intensive care unit (ICU) admissions and eight influenza-related deaths in this province. If vaccination rates are significantly reduced, these numbers could grow.

In 2014, Newfoundland and Labrador had the second lowest proportion of people who received the flu vaccine of all provinces. Therefore, the government should be trying to improve this province’s vaccination rate, not erode it.

For many patients, the family doctor’s office is the only place in their community where they have an opportunity to receive the flu shot. For instance, we know there are 14 communities that have a doctor’s office but did not have a community health flu shot clinic last year.

The government says it can maintain current vaccination rates by increasing the capacity of community health flu shot clinics. To double the size of the public system in a single year and to expect up to 65,000 people to switch to a new site is not a credible plan. Availability does not guarantee access. 

The government’s proposal also restricts patient choice. Some community health flu shot clinics are only available at select sites on certain days and at specific times. Physicians have also been told by patients that there can be long lineups for public health flu shot clinics. Some elderly patients lack mobility and physical stamina to wait in lineups. Many doctor’s offices also hold special clinics after hours or on weekends to accommodate the volume of people seeking flu shots.

Physicians recognize that the immunization services provided by community health clinics are very beneficial, but dismantling the parallel physician-provided delivery channel is a step backward.

Government’s decision is clearly intended to save costs, yet even on this issue it fails scrutiny. If the government had conducted a cost analysis it would have found increased costs to the system, such as the following.

The time that physicians normally set aside for flu shot clinics and appointments will be used to see other patients who are waiting for their medical appointments. Doctors will be compensated from MCP for these other services, so it is not clear to us how this decision saves money.
The regional health authorities will have to significantly increase their capacity to deliver flu shot clinics to try and maintain the current vaccination rate. This will require money for longer hours and more staff to cope with the tens of thousands of additional patients.

If this decision results in fewer patients being vaccinated for influenza, we will also see an increase in ER visits, hospitalizations and ICU admissions, which will add additional costs to the system.

How can the government contemplate eliminating the biggest delivery channel for flu shots when it has not demonstrated that money will be saved or that patients will not be impacted? The whole idea is ill-considered, puts lives at risk, and needs to be reconsidered.

 

Dr. Lynn Dwyer, president
Newfoundland and Labrador Medical Association
Family physician, St. John’s

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