6 per cent solution for better health care
TheStar.com – opinion/editorialopinion
Published On Wed Dec 21 2011. Armine Yalnizyan
Non-negotiable. Finance Minister Jim Flaherty’s health plan was presented as a fait accomplion Monday. A guaranteed 6 per cent more federal cash for health care each year for the next five years, but thereafter the Harper government will reduce its level of support.
And there is no plan to ensure that money buys the kind of change that tackles Canada’s growing health and regional disparities. As far as the Conservatives are concerned, that’s not their issue.
So now it’s up to the provinces and territories to show Canadians what it means to govern. Anyone can shovel taxpayers’ money out the door but it takes a plan to turn that money into a 6 per cent solution that benefits people in every part of the country.
Next year, the 6 per cent escalator will provide the provinces and territories with $1.6 billion more. Over the next five years, it will put another $26 billion into their coffers. That’s more than enough to make changes that can transform our system.
The 2004 federal-provincial Health Accord pumped $41 billion into provincial and territorial budgets. We achieved huge improvements in diagnostic equipment and Canadians saw wait times for cancer care, cardiac, vision, hip and knee surgeries plummet. The lesson learned: When we keep our eyes on the prize and have a focus, we can make a real difference.
Here are three ways to spend that $1.6 billion next year that could lever increased efficiency and equity.
• Lower costs through economies of scale.
One of the two fastest drivers of health expenditures is pharmaceuticals. Canadians spent $26 billion on prescription drugs in 2010, 46 per cent of which was through the public purse. We pay retail for every pill.
There are many drugs that Canadians turn to repeatedly, in growing numbers every year. Why not coordinate our purchases? We did just that when the anthrax scare of 2001 triggered a run on the antibiotic Ciproflaxin. The federal government’s emergency preparedness plans shaved $3 off the original $4.70 price per pill, saving millions on just one drug.
The feds could work with the provinces to set up a “buyer in chief,” trimming costs for everyone by flexing our purchasing-power muscle through a single-payer system. Taking $600 million from the escalator, matched with existing expenditures by the provinces and territories, could start a process that, over five years, could build toward a pan-Canadian formulary of the 100 most commonly prescribed drugs, negotiate a better price through bulk buying, and collectively save ourselves billions.
• Bend the cost curve by improving health.
The biggest gains in health outcomes over the past century have come about through public health measures that reduce preventable illnesses. Think about the impact of clean drinking water and waste management systems, or anti-smoking campaigns.
Simply put, healthier people require less health care. Small investments today can produce big payoffs down the road.
Take oral health. Canadians will have spent $13.7 billion on dental services in 2011, only 5 per cent of which was publicly funded. Cavities are a 100 per cent preventable disease. A mounting body of evidence is showing the linkages between poor oral health and higher incidence of diabetes, cardiovascular diseases, pneumonia and Alzheimer’s.
Relaunching a Saskatchewan initiative that started in the 1970s could bring a preventive, child-focused dental care program to every child under 14 in their schools for an estimated $564 million nationwide. The feds could provide a 50-cent dollar for every province that signs up. A $300 million investment through the new funds, matched by what the provinces already spend, would save billions down the road and improve lives in the process, one healthy smile at a time.
• Allocate resources strategically.
The biggest challenge to our system is the rise of chronic diseases. We really haven’t tackled the integration of care between our hospitals and our communities. Far too many people turn to our hospitals for want of options for primary health care in the community.
We know how to get savings downstream by investing in upstream investments. It’s time to put that knowledge into action. We have plenty of successful pilot programs in the community that can be scaled up. Take $700 million from the escalator funds today and start the process of expansion tomorrow.
Those are just three ways to advance a 6 per cent solution. And that’s what Canadians want: change that buys better health, better care and better control of costs. Six per cent: small change that can buy transformational change for Canada’s most treasured social program.
Armine Yalnizyan is senior economist at the Canadian Centre for Policy Alternatives.
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