Canada’s health care system is an expensive under-performer because it is out of sync with both international trends in the delivery of care and with changing consumer demand, experts on health care reform told delegates to the National Health Leadership Forum Monday.
Not only does the system over-test and over-treat patients, it’s too “physician-centric” and more concerned with garnering higher salaries than it is with providing the sort of appropriate, quality care that consumers want, argued Dr. Anne Snowdon and Dr. Charles Alessi at a session of current global trends in health system innovation.
While systems around the world are creaking under increasing financial pressure, Canada is particularly vulnerable because of inertia, and will continue to slide down the ranks in any international measurements of systemic performance and health outcomes.
Snowdon and Alessi noted that while systems around the world are creaking under increasing financial pressure, Canada is particularly vulnerable because of inertia, and will continue to slide down the ranks in any international measurements of systemic performance and health outcomes, though it spent $215 billion (or 11 per cent of its gross domestic product) on health care in 2014, including $62.6 billion on hospitals, $34.5 billion on drugs and $31.4 billion on physicians.
Alessi told delegates that Sir Murray Brennan of the Sloan Kettering Cancer Institute was bang on when he asserted that, “We over-diagnose. We over-investigate. We over-treat for minimal benefit, and just worse, we design reimbursement to maximize revenue. We also rarely ever define the expectations for patients.”
By comparison, in England, which spends roughly the same total amount to deliver health care to a population roughly twice the size of Canada’s, “The link between physician clinical behaviour and fiscal consequence for clinicians is embedded, leading to more ‘risk’ being managed rather than excluded,” the co-chair of the National Association of Primary Care in England and adjunct research professor at Western University’s Ivey School of Business added.
The system must become more “consumer driven” and understand that in the modern, digital world in which there are millions of health apps and patients are using social networks to “run their own clinical trials to see what works,” that Canadians no longer “presume that the health care provider is the expert.” – Anne Snowdon
“The big difference is that in England, we’ve been used to having primary care deliverers being responsible for population health for many years,” Alessi later said in an interview. “There’s two ways one can manage a condition. I can look at you and think about the conditions you could have and test you for everything. Or I could look at you and think, because we have such a longitudinal relationship which goes back many years and will continue for many years, in terms of the most likely things you could have, and actually be a little more sparing in the way that I manage your condition. There’s immediacy in delivery of care, when you exclude risk, where you have to do everything immediately and so you do a lot of things you don’t need to do.”
The consequences on a health care system are enormous, both in terms of overall cost as well as patient health, as patients in Canada are often provided treatments that could “do more harm than good,” Alessi added.
System Must Catch Up to the Times
Snowdon, chair of Western’s Ivey International Centre for Health Innovation, contended that Canada’s health care system is also burdened by a physician-centric approach to delivering care and swamped with waves of chronic care patients arriving in hospitals, and skyrocketing costs that threaten to spiral out of control because it focuses, “on the disease or diagnosis. It’s not about the person.”
The system must become more “consumer driven” and understand that in the modern, digital world in which there are millions of health apps and patients are using social networks to “run their own clinical trials to see what works,” that Canadians no longer “presume that the health care provider is the expert,” Snowdon said.
Canada will eventually “hit a fiscal cliff where we can’t afford not to [make major cuts in health care]. And then you’re going make snap decisions too quickly and probably go the wrong way. We’re going to end up debating what we no longer pay for. That’s not a good or achievable model. And it’s certainly not where other countries are going either.” – Anne Snowdon
Snowdon later said in an interview that, “Some people say that making the system less physician-centric is moving mountains. Some people say that it’s a revolution. My answer to that is that the consumers are already there. We’ve lost our connectivity with consumers because they’re in the on-line, mobile digital world mostly, and yet we as a system are by-and-large disconnected from that world.”
Unless changes are made within Canada’s health care system, Canada will eventually “hit a fiscal cliff where we can’t afford not to [make major cuts in health care]. And then you’re going make snap decisions too quickly and probably go the wrong way. We’re going to end up debating what we no longer pay for. That’s not a good or achievable model. And it’s certainly not where other countries are going either.”
Among needs within the system, Snowdon and Alessi argued, are: supply chain innovation, traceability from bench to bedside,” so that things like faulty equipment can be easily tracked and taken out of commission; developing portable electronic health records so that a patient’s health information is put in their own hands; finding national mechanisms to scale-up beneficial innovations; and providing greater transparency about the options that are available for treatment, so that consumers are more involved in determining appropriateness of care.
“We need to put the population in charge of defining value, because guess what, they will anyway,” Snowdon said.
Published in Partnership with iPolitics.
