Universal Health In Canada And Its Challenges

Study on health in Canada titled "How to bend the cost curve in health care" by Steven Lewis and Terrence Sullivan.

Apologies for the formatting. 

Some excerpts (bold mine):

"...Despite some promising innovations across Canada, medicine remains for the most part a cottage industry of small businesses in which neither payers (governments) nor providers adequately

scrutinize quality, health outcomes or resource-consumption patterns. And still governments wonder why it’s hard to contain costs we doubled real health care spending in 14 years..."

"Behold the results. Serious access, safety, quality and fairness problems remain. The spend-to-greatness experiment failed. And now, following the fiscal fallout from the 2007-08 worldwide financial crisis, governments once again want to bend the cost curve — down, not up. The new mantras are “value for money,” “appropriateness” and “waste reduction.”

"...Good luck to ’em. Costs rise, and health care absorbs all money made available to it, because the system is designed that way. It will take blood and guts to redesign it. The good news is that there is nothing inevitable about either the level or the rate of increase in health care spending.

Bending the cost curve is technically simple: governments can decide to allocate less money, just as they did in the mid-1990s."

"...Scientific evidence, quality improvement, sound policy, thoughtful incentives, cultural change and political courage, judiciously applied, are the key ingredients of a successful transition to a lower-cost future. The real issue is not how much we spend or even the rate of growth we attain; it is what health value we achieve for what we spend. The bad news is that there are few painless and easy-to-implement measures that would significantly and permanently alter spending growth patterns. That is why governments always flinch unless and until there is literally no alternative."

"...Similar logic pervades the entire system. Health care equates productivity with service volumes, not health outcomes. Individuals and organizations get paid regardless of whether the services they deliver are appropriate or inappropriate, high quality or mediocre. In the US Medicare system for the elderly, per capita spending is three times higher in some regions than in others, with no difference

in outcomes or patient satisfaction."

"...(policies and practices in Canada) thwart innovation and increase costs. The incentives under which health professionals work strongly influence the organization, delivery and cost of services, and they are among the most resistant to change. Enhanced credentials require extra time to produce graduates, and they create barriers to entry for lower-income groups. Perhaps even more worrisome, they may further fragment the system as students spend more time in parallel educational streams and graduate-level training programs that promote distinct theories of health."

"...health care is famous for contradicting the normal economic laws of innovation. Computers, bicycles and smart phones get cheaper as they get better. Health care technology gets marginally better and vastly more expensive."

"..Costs are price times quantity. Reducing either will alleviate pressure on total costs, and reducing both will compound the benefit. Canadian health policy has rarely addressed price, and as a result, Canada’s health care system fares poorly in international comparisons of value for money."

"...many factors contribute to drive health care costs up. It will take nothing less than a

sustained, carefully designed, multipronged strategy to avoid reliving the experience of the past 20 years. 

"...Many elements need to change: culture, incentives, education, structures, relationships, accountability, transparency. The first step has to be a shared commitment to improving value for money based on recognition that the system just isn’t good enough."

"...The system does a woeful job of managing the chronic conditions that account for up to two-thirds of all spending. It puts the elderly at risk of debilitating and costly health breakdown by denying them help until a crisis occurs. Canadian medicare has effectively deinsured home support and

community rehabilitation. Deferring maintenance costs exacts an enormous and partly avoidable subsequent cost."

"...A family doctor at Seattle’s renowned Group Health Cooperative works 40 hours a week

and has a roster of 1,800 patients, several hundred more than a typically beleaguered Canadian counterpart."

"That conversation begins with truth telling.

Compared with other countries, Canada has a woefully underdeveloped health information culture. Citizens have little access to health information that would help them make more informed decisions about whether and where to undergo treatment, or about the quality and value of the system. When organizations such as the Canadian Institute for Health Information publish even the most innocuous comparative, high-level performance data, the poor performers will often try to explain away their failures, and on occasion provinces threaten to withhold data or cease to participate in future studies. It is virtually impossible for Canadians to obtain information such as a surgeon’s complication or mortality rate, or a hospital ward’s readmission rate — information that is published in newspapers in many American cities."

"The irony is that the absence of full public disclosure of what insiders know to be the system’s deficiencies undermines the case for widespread and rapid reform. The public remains fixated on access problems and is largely oblivious to the issues of variation, overuse, poor outcomes and waste.  

Ultimately, there can be no transformation unless the public considers it necessary and legitimate. Without full and sustained public reporting on the quality, fairness and efficiency of the system and its components, the status quo will prevail over attempts to bend the cost curve, take on the guilds, insist on real accountability or reinvent the workforce. When the massive US Veterans Health Administration reached its nadir — ruthlessly portrayed in the movie Born on the Fourth of July— it changed on a dime. Within four years, it closed 55 percent of its hospital beds, opened over 300 new primary care clinics and improved its preventive health performance across the board."

"In Canada, we talk as if we’re mad as hell and not going to take it anymore, but our revolutionary zeal is easily deflated. The system does just enough in small increments to quell a sustained uprising. Our expectations are modest, and we are grateful when they are met at great cost. Only a deeper and more forthright commitment to truth telling can free us from complacency and give us the courage to act decisively to make the changes long called for and seldom acted upon."

Amen.

All points touched on here over the years through simple observation and experience.

In the end, we accept mediocrity.