Social Policy in Ontario

More health care doesn’t necessarily mean better care, a point made powerfully in a new study from the United States that estimates 30 per cent or more of health-care spending, or perhaps $700-billion a year, is wasted. The findings deserve a look from Canadians, whose appetite for care seems limitless, leading to fears that health care will soon devour the provinces’ operating budgets.

Some regions in the U.S. spend more than twice as much per capita as others on the federal health program known as Medicare, which covers senior citizens and some disabled people. Rates of poverty and sickness explain little of the variation. “Most of the spending was due to differences in use of the hospital as a site of care (versus, say, hospice, nursing home or the doctor’s office) and to discretionary specialist visits and tests. Higher spending on these services does not appear to offer overall benefits,” says the Dartmouth Institute for Health Policy and Clinical Practice.

It would be useful to know what variations exist in medical practices among provinces and regions, which ones are worthwhile and which should be cast aside. What is Canada’s Minnesota – the state is an efficient, high-quality medical provider – and what can be learnt from it? Canada spends $129-billion on the public system, so if 30 per cent is wasted, the potential savings are roughly $40-billion.

Some efficiency experiments are under way, such as a move in British Columbia and Ontario toward paying hospitals per “episode” of care. In theory, that should reward the most efficient hospitals, but the Dartmouth study suggests that treating the “less sick” lowers average costs, presenting an appearance of efficiency even as it wastes money. New models of payment should reward health-care providers for improving quality while reducing unnecessary care, Dartmouth says.

The institute followed 255,000 people. Those who moved to regions with “high-intensity” medical practices featuring lots of tests and services had a whopping 63-per-cent increase in diagnoses, compared with those who moved within low-intensity regions. But it doesn’t follow that finding and treating all that sickness was helpful.

“Why do some primary care physicians order more than twice as many CT scans as their colleagues in the same practice?” the study asks. “Why are the rates of coronary stents three times higher in Elyria, Ohio, compared with nearby Cleveland, home of the famous Cleveland Clinic? And most important – what do these differences mean for patients?”

Intensive services may not affect quality, but they do drive demand. It’s an unsettling finding that Canadians should pay attention to.

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