Reducing isolation — What values should we consider?

Imagine you have advanced kidney disease and your doctor has said you should start dialysis — a life-saving treatment that will mechanically clean harmful substances from your blood, as healthy kidneys do. In most cases, patients must be hooked up to dialysis equipment three times a week, for several hours each time. Jobs and family life have to be scheduled around these treatments, which continue life-long.

Now imagine that you live in a remote community, 800 kilometres from the nearest dialysis centre, and you will have to fly out for treatment. Starting dialysis means you have to move to the city, far from the cluster of northern islands where you have lived your whole life. You must either leave your family, work, and community – or ask your partner and children to move with you.

You are not alone, although this fact is hardly a silver lining. Close to half of all adults in your community have kidney disease, mostly due to very high rates of diabetes. Rather than uproot their families or move so far alone, some of your neighbours have refused dialysis or given up on it, knowing they risk serious consequences including an earlier death.

Now there’s news that a dialysis facility may be built on one of the islands. You would be able to live at home and travel about half an hour for treatment – by boat in the summer, snowmobile in the winter. There are also plans to use the investment in the treatment centre to help launch a new program of public education on kidney health and diabetes prevention for the whole community, young and old.

Down south and in your region, health care decision-makers are debating whether this six-station dialysis centre will be good value for money.

Some people argue that value for money means more than cost-effectiveness. They say that decision-makers should not be looking only at the bottom line, but also at people’s quality of life. Others say the system is stretched to the limit and we should only build new facilities that can clearly save money.

What do you think?

1) In situations where geography is a barrier to people getting the health care they need, what factors should decision-makers take into account?

2) If you lived in the community described in this story, would you feel differently about how health care spending decisions should be made?

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This scenario is based on a true story, “Island Lake dialysis centre becomes a catalyst for change,” featured in the Health Council of Canada report Why Health Care Renewal Matters: Lessons from Diabetes (p. 61-62).