Studying health care to death

Posted on April 23, 2009 in Governance Debates, Health Debates – Full Comment – Studying health care to death
Posted: April 22, 2009.   Dr. David Gratzer

Liberal MP Keith Martin made headlines this month by suggesting that our health care system is falling short and needs to be reformed. Dr. Martin, a B.C. physician, is right.

Why? Start with the bottom line. The cost of the system continues to grow and grow. Just in November, for example, the Canadian Institute for Health Information (CIHI) estimated that total health care costs increased from $162-billion in 2007 to $172-billion in 2008, a 6.4% jump — well ahead of inflation and population growth. Health care is the single biggest spending item of every province; health costs show no sign of slowing, unlike the economy itself.

As health care comes back on the radar, members of the political class will begin clamouring for a long, serious study of the issue. That’s not totally indefensible: Governments across the country seem lost about how to reform the health care system.

Funny thing about these studies, though: they are released with great fanfare, and — after stirring up months of debate — they disappear, as if they wandered off into some strange Bermuda Triangle of policy.

This was the fate, for example, of the nearly 400-page report by former Saskatchewan premier Roy Romanow. Entitled Building Values: The Future of Health Care in Canada, it appeared in 2002. Quick — can you name any of the key proposals made in Romanow’s exhaustive study? Succeeding it was a smaller, merely 75-page health care report by a Senate committee released in 2003. Perhaps hoping to hold the public’s attention a bit longer, this report carried the subtitle Time to Act. The urgent tone did not save it from also fading from memory.

Every province released at least one major study of health care in the past dozen or so years, yet the reports didn’t seem to fare much better. Quebec, for the record, has had three studies. That ties the record of Alberta. That province started with a commission led by Don Mazankowski that reported in 2001. Like its federal cousins, the Mazankowski report also sleeps undisturbed on the shelf — though the Alberta government commissioned two more reports (largely to discuss the Mazankowski report).

That’s not to say there hasn’t been change in Canadian health care. At the provincial level, there has been tinkering: Alberta junked its nine regional health boards after having created them in the 1990s; Ontario re-invented its boards, having scrapped them in the late 1990s.

The real change, however, has been in the decision to spend, spend, spend. That’s what has driven the jumps in spending documented by the CIHI — from $3,671 per capita in 2002 (remember: the year of the Romanow report) to the institute’s latest projection of $5,200 in 2008.

In some ways, the reports were obsolete because regardless of their recommendations, governments found a simpler option: throw money at the problem. With the economy booming in recent years, health costs that outstripped inflation didn’t seem particularly worrisome. Indeed, governments across the Western world have done just this (consider that spending basically doubled in Britain over this time period).

But the core problems remain. Looming largest is the issue of how we can best prepare our health system to deal with the policy implications of our ageing population and chronic diseases.
Our health care system draws its inspiration from the middle of the previous century, but it must grow with and respond to the needs of patients living in the 21st century. Canadians suffer when decision-makers fail to put patients first. (Without meaning to pick on Roy Romanow, but you don’t find the word “patients” until page 20 of the online version of his report.)

This problem doesn’t need the Band-Aid of more money; it needs a fundamental re-think, which means embracing ideas like greater efforts at prevention (favoured by the left), better use of information technology (supported by the centre) — and, yes, user fees and greater competition (promoted by the right). As Dr. Martin notes, “the absence of competition leads to inefficiencies in our health system, a dearth of innovation and compromised care.”

It seems that Canadians will soon find themselves in a health-care debate — again. This time, hopefully, politicians will have something to say, rather than report.

National Post

Dr. David Gratzer is a physician and author.

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