Dr. Robert Ouellet and U.S. President Barack Obama have something in common.
Both are urging fundamental reform in the way their countries approach health care — and both are getting strong resistance from those who favour the status quo.
The president of the Canadian Medical Association has spent most of the last year trying to interject some common sense into Canadian health care. Unfortunately, Canadians prefer to keep plugging along just as they have in the past, despite mounting evidence that our system is inefficient and doesn’t serve patients nearly as well as it should for the money we spend. Two recent reports make that point. The latest health statistics from the Organization for Economic Co-operation and Development show that Canada was the fifth-highest spender among the 31 countries assessed in 2007. Despite that, we have below-average numbers of doctors, nurses, acute care hospital beds, CT scanners and MRIs.
Another study, the Euro-Canada Health Consumer Index, looked at a variety of health-care statistics from 32 countries and tried to assess “bang for the buck” in each health-care system. Canada finished last.
The two think-tanks responsible for the study don’t claim their methodology is perfect, but the conclusion is clear: Canada can do a lot better for the money it is spending.
That’s the point that Ouellet has been trying to drive home, and he has some ideas about how we can do it. His central message is that we should have a patient-centred system. “If the healthcare system is not centred on the patient, who is it centred on?” he asks.
Consider the never-changing list of intractable Canadian healthcare problems: We have long wait times for a wide variety of medical services. Our emergency room rooms are clogged. Our hospitals are often filled with people who should be getting long-term care instead.
We are not the only country to have these problems, but others have found solutions.
Ouellet has visited England, Denmark, Belgium, the Netherlands and France to study their systems. All offer universal access, as does Canada. In England, he found that teams of doctors, nurses and hospital administrators had worked to streamline emergency room procedures, and there is now a fourhour wait time benchmark.
Hospital funding in Britain has been changed so that they are paid for the services they provide.
In Canada, our hospitals get a global budget that reflects the increase the government is prepared to pay, combined with a guess at service volume. Every patient the hospital sees drains that budget, leading to the dreaded deficit and the predictable annual scolding from government.
In Britain, patients bring the hospital revenue, so there is an incentive to treat more, not fewer. That sounds costly, but it is balanced by tough efficiency targets.
In Denmark, long-term care is a municipal responsibility and if there is no space, the municipality has to pay the hospital. That provides an incentive to provide long-term care homes. In Canada, one government pays either way, so there isn’t much incentive.
Denmark also has a safety valve for cancer patients. If they can’t get treatment in one month, they are allowed to go to a private clinic and the government health system pays.
The idea of an alternative to the current monopoly on most major forms of health care is critical to the idea of a patient-first system, Ouellet argues. Without it, there is no real pressure for government health care to deliver timely results and no alternative for patients when it doesn’t. Ouellet is a radiologist who runs a private clinic providing service to those whose health benefits cover it.
Ouellet’s point makes sense, but as soon as “private health care” is mentioned in Canada, we launch into comparisons with the American system, surely the most costly and least efficient in the world. Our universal healthcare system is held up as a Canadian value, as if we were the only ones who had it.
It’s an irrational way to see the situation. There is already substantial private-sector involvement here in things such as diagnostic testing, and that’s not an issue. When we use supplementary medical benefits to pay for an eye exam, prescription drugs or physiotherapy, we are using private medicine. These are things government provides in limited supply or not at all. Should we ban these extras?
As Ouellet envisions it, a somewhat expanded private sector would not be a parallel system drawing away doctors from public health care, but an opportunity for doctors to do supplementary work without restrictions on their operating time or long waits for diagnostic tests. The bulk of any physician’s billing would still be in the public system.
Ouellet says health ministers have been listening, though there is limited action so far. When government does act, it is usually to throw more money at the problem and hope it will resolve itself. As the international studies show, Canada’s problem is not a lack of money, it’s a lack of thinking about how we spend it. We should start by being more openminded, and by considering how others have dealt with the same problems.