What Canadian health care lacks is action, not innovation

Posted on in Health Delivery System

TheGlobeandMail.com – News/Politics Insider
Jun. 26 2014.   André Picard

Earlier this week, Health Minister Rona Ambrose named a new advisory panel on health-care innovation.

It’s not a half-bad idea to tap into the ideas of a bunch of smart people – and the panel members are a stellar bunch – to “foster the kinds of innovation that improve the quality and effectiveness of our health-care system” (the minister’s words).

But does Canada’s $211-billion health-care system really need another colonoscopy by brainiacs?

And is appointing a panel what now passes for action in Ottawa, where the government of Stephen Harper has washed its hands of leadership on the health-care file since it took power in 2006?

Since the report of the Royal Commission on Health Services in 1964, we have had more than 40 high-level reports from task forces, commissions of inquiry, expert panels, standing committees, working groups, think tanks, policy groups and so on.

Vast swaths of Canadian forest have been razed to publish their recommendations.

There is no lack of ideas about what is required to modernize and transform the health system to make it more cost-effective, efficient, and deliver better care for patients.

There is plenty of innovation in Canadian health care. In fact, every problem we have has probably been solved 10 times over – on a small scale. As former health and welfare minister Monique Bégin famously said, Canada is the “land of pilot projects.”

But, in our decentralized and unco-ordinated health system (non-system being a more accurate description), we do a poor job of sharing our successes and an even poorer job of scaling them up.

What we lack is not innovation, it’s action.

What we really need in Canada is a task force on implementation.

And make no mistake, we know what needs to be done.

In fact, what is striking about the dizzying array of reports on health-care reform that this country has produced in the past half-century is that they essentially all reach the same conclusions.

The priorities for reform can be easily summed up in two short lists – one for the delivery side and one on the payment side.

First, on the delivery side:

Primary care: We need to essentially take our hospital-based care system and turn it on its head to make community-based primary care the focus. We need to move away from an acute, episodic care model to a chronic care model. Every Canadian needs a medical home, a central co-ordination point for their care – preventive, acute and chronic – and an electronic medical record. Care should be delivered by teams, not individual practitioners.

Drugs: We need to extend universal health coverage to prescription drugs. That doesn’t mean paying for every drug from Aspirin to Zyprexa, nor does it require a vast new bureaucratic infrastructure. It means making insurance for essential prescription drugs mandatory.

Community care: We need to treat people where they live, in the community. That means minimizing our use of expensive, warehouse-style institutions like hospitals and nursing homes and investing in home care and other community-based programs.

Social determinants: We need to stop pretending that health is merely a medical issue. Education, food and housing, a decent income, a sound environment and a sense of belonging have more of an impact our health than sickness care. In short, we need to invest more in the prevention of illness rather than wait for people to get sick and treating them.

And on the funding side:

Quality: Safe, prompt and effective must be the guiding principles for care delivery. The publicly funded health-insurance system (medicare) needs to pay for what works and what provides the best return on investment.

Labour: More than two-thirds of health spending goes to paying employees. We need to ensure that all health professionals work to their full scope of practice and they are paid fairly (but not overpaid).

Complex patients: One per cent of patients account for 25 per cent of costs, and 5 per cent account for half of all spending. If we treat these high-use patients proactively, rather than constantly cycling them through emergency rooms (and, to a lesser extent, the prison system), we will get overall spending under control.

Private-public mix: Every universal health-care system has a mix of private and public funding. Instead of our circular “public good/private bad” or “private good/public bad” arguments, we need to get the mix right to ensure no one is denied essential care and to maximize choice. We also need to strive for a well-regulated private system and a well-managed public system.

We don’t need a bunch of fancypants consultants to tell us what needs to be done. We know that all too well.

We need them to tell us how much it will cost (and it won’t cost more than our current inefficient system), how long it will take, and how to get the ball rolling.

We deliver good medical care in Canada, but we do it in spite of the system, and we don’t do so in a cost-effective or efficient manner.

Virtually all the problems we have in Canadian health care are engineering and administrative issues. We need a structure that will foster and reward continuous improvement, not one that encourages and reward stagnation.

The most useful thing this blue-ribbon panel could provide is sound advice on how to break down the silos and overcome the turf protection of various interest groups in the health system to ensure that we implement what we already know needs to be done.

If the advisers extraordinaire can provide a blueprint for achieving that, their recommendations will be worth the weight of all the slaughtered forests of health inquiries past.

If not, theirs will be yet another report on dusty shelf, straining under the weight of unfulfilled promises.

André Picard is The Globe’s public health columnist.

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