Johan Hjertqvist, Swedish health care reformer and Frontier Centre Advisory Board Member
In almost every Western society today there is an intense debate on the future of health care: How to guarantee a better outcome from the growing (but apparently still insufficient) resources allocated for health care? How to transform public health care from a bureaucratic monopoly into a dynamic network of services, responding not only to need but even more importantly to demand? How to balance the conflict of interest between the roles of citizen/taxpayer, patient and consumer? How to move from a sterile focus on costs to a total preoccupation with improved health outcomes? How might the wishes of health care consumers be met by making each individual not only a more powerful decision maker within the system but also more responsible for the decisions that he or she takes? And what do the tools look like in practice that will make these radical changes possible? How can we introduce new incentives to the system, create a new relationship between funding and provision, purchasing and delivery, and decentralise influence in a way that will engage the health care workers of today and tomorrow? How can we build a health care network that is guided by best practices and consumer-centred benchmarks, and integrates all of the vital elements of public and private, big hospitals and small scale entrepreneurs, established methods and new communications solutions?
Everywhere you find the same questions regarding costs, waiting lists and the lack of services that fail to meet the demanding expectations of the Western health care consumer and provider. In Europe more and more national governments understand the political ramifications of this discussion and the need to put a consumer focus at the heart of health care provision. The old political blinkers are rapidly being shed, new instruments and forms of co-operation are suddenly becoming not only thinkable, but do-able.
Rigid ideology is falling out of fashion. The European Union, for example, has named health care a growth industry with a major contribution to make to the goal of seeing the Union become the most competitive economy in the world by 2010.
To a keenly interested outside observer, such as myself, Canada lacks much of this openness to new ideas. Of course one finds new bold thinking here and there, as in Alberta and among the nation’s think tanks, but these examples on the whole look like exceptions. However, the numerous reports now emerging from different sources, together with the vivid public debate now seizing the country, lead me to think that Canadian health care policy is moving into a vital new transformative phase. Sharp analysis and bold proposals are badly needed to lay out the case for the tough policy decisions to come.
The AIMS Definitely Not the Romanow Report contributes to this exchange of ideas and knowledge in a way that merits applause and congratulations. Focussed, sharp and constructive, it cuts through the arguments and illusions of a conservative establishment that advocates minimal change. Change is badly needed and change there will be. The question, as this report so eloquently makes clear, is: Do the politicians want to be influential in reshaping the country’s health care system or are they going to leave its future in the hands of others? It is up to them to decide. The best way to lose credibility is to neglect the system’s genuine problems and to deny the need for reform. Or, as a close advisor to the German Social Democrat Chancellor Gerhard Schroeder recently told me at a centre-left think tank welfare seminar, “To tell the world not to rock the health care boat is the best way to lose the next election!”
AIMS has done a great job commenting on the Commission on the Future of Health Care in Canada — the Romanow report — and thus on the whole pattern of today’s health care reform agenda, an agenda which is not unique to Canada but is common to the Western industrialised world. This report delivers not only powerful, efficient and telling criticism of the status quo and its defenders but, even more importantly, it offers challenging and thoughtful proposals for the future.
The consumer will come to power in the health care system regardless of the political biases of parties and interest groups. Those who first seize on that insight and turn it into a strategy for reform today will create an indispensable foundation for the future. AIMS has performed a great service for Canadians in laying out the intellectual case, in your national context, for the changes that are to come.