Crisis holds hope for health care – Opinion – Crisis holds hope for health care
February 27, 2009.   Carol Goar

Despite his reputation as an iconoclast, Ted Ball sent out his latest health-care report this week with a certain amount of trepidation.

It contained a glaring red flag. He pegged the level of waste in Ontario’s medical delivery system at 30 per cent. (The Toronto health-care consultant actually thinks it is closer to 40 per cent but he didn’t want to be too provocative.)

He waited for a torrent of angry – or at least skeptical – emails from hospital administrators, health-care professionals and provincial bureaucrats.

But the reaction was surprisingly muted. What this suggests to Ball, who has been arguing for 25 years that Ontario spends too much and gets too little out of its health-care system, is that the message is finally getting through.

He expects Queen’s Park to hold the line in next month’s budget. And he thinks health-care leaders will respond pragmatically, possibly even creatively.

For Ball, this is a breakthrough moment. “This is perhaps our best opportunity for a long overdue transformation,” he says. “I believe the current financial crisis is about to provide the tipping point.”

The first challenge, he says, will be to redeploy the roughly $12 billion that is now being spent on unneeded medical tests, inappropriate drugs, redundant paperwork, political lobbying, rivalry between doctors, nurses and other health-care professionals, and competition between institutions.

Putting taxpayers’ money where it will do the most good (home care, for example) sounds simple and sensible. But Ontario’s health-care system is riddled with vested interests, institutional barriers and processes so ingrained that people consider them sacrosanct.

The next task will be to stop rewarding hospital executives for increasing their patient volumes. Their remuneration should be based on how effectively they work with other partners in the health-care system, Ball says.

This, too, will require a major shift in thinking. Most hospital boards equate spending with success. Most management practices are borrowed from the world of business, where bigger is better.

The third imperative, Ball says, will be to move resources from “sick care” to disease prevention. Ontario has a ministry of health promotion, but it gets a trickle of funds compared with dollars gushing into hospitals, doctors’ salaries and drug benefits. Moreover, the government doesn’t consider smog, malnutrition, illiteracy or substandard housing health issues.

“What is the point of spending $40 billion annually on health care if we are just getting sicker and sicker?” Ball asks.

Finally, Ontario’s 14 newly created regional health boards (known as LHINS or Local Health Integration Networks) will have to show strong leadership, he says. The government has given them a mandate to pull all the players in the health-care system – hospitals, nursing homes, family health teams and community agencies – together. It has offered them the chance to set goals, allocate resources and build relationships.

“We cannot allow any LHIN to fail,” Ball says. “If they fail, we all fail.”

He sees no need to cut nurses. They’re one of the best bargains in the health-care system. Nor does he see any need to redesign, restructure or overhaul medicare. Former health minister George Smitherman came up with a fine blueprint. What is required now is the political will to implement it.

It has become a cliché to say that adversity creates opportunity. But in the case of Ontario’s overpriced, underperforming health-care system, it might just be true.

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