Review

Chronic Condition by Jeffrey Simpson

Chronic Condition written by the Globe and Mail’s national affairs columnist Jeffrey Simpson argues that Canada's health care system needs to be dragged into the 21st century.

When rated against other healthcare systems in developed countries it usually ranks near the bottom on outcomes, satisfaction, and equity. We can do better but unfortunately healthcare is something of a “third rail” in Canadian politics that no politician dares touch out of fear of never getting re-elected.

Our drug and salary costs, two of the most significant cost drivers are among the highest in the OECD. Simpson points out that “The health-care system features huge bureaucracies, large institutions, powerful professional associations, formidable unions, and well-paid administrators.” These powerful groups tend to absorb most new dollars allocated to health care with improvements regulated to the margins.

Simpson compares our system, one with a high degree of unionization, large and sluggish bureaucracies, and a focus on process over outcomes, to those systems with a higher involvement of the private sector offering a greater focus on outcomes and positive change as it is necessary to compete or perish. He says the strongest opponents of change in our inefficient public system are organized groups from within who are motivated to protect what they have.

Our publicly funded system is “Deep, narrow and expensive, as opposed to the systems elsewhere that are somewhat shallower, wider and cheaper,” says Simpson. To be fair, he also identifies that a greater role for private payment also presents both opportunities and risks. On one hand you have increased resources, greater consumer choice, and a more responsive system. On the other hand, that is all potentially at a cost of “considerable equity challenges” and higher total health care costs including for those in the public sector.

His remedies include paying greater attention to the social determinants of health, relentless pursuit of efficiency gains, measuring and rewarding our best performers and no longer rewarding the worst ones with across-the-board global budget increases, getting affordable team-based care accountable to the health authorities who employ them, delivering patient centered care instead of provider convenient 9-to-5, Monday-to-Friday care.

The performance of Regional Health Authorities should be measured, reported, and rewards offered for improved results without prejudging how and where patients are best served for the lowest cost and highest quality, “a patient-centered system should be neutral about the deliverer of the service, private or public”.

Other ideas for system improvement include de-hospitalizing health care with more surgeries and out-patient services performed outside hospitals because the more services safely removed from hospitals, the more hospitals can focus on the work for which they are best equipped, acute and emergency care.

Norm Letnick is MLA for Kelowna-Lake Country and currently the opposition's health critic. He periodically reviews a new released that deals with health issues for Okanagan Weekend.