Ineffective Health System Needs Hard Questions

Media Appearances, Healthcare & Welfare, Frontier Centre

In last week's column I posed some potential questions that can be asked of political candidates in regards to their health policy.

While questions about curbing the unsustainable growth in health-care costs, setting health outcome goals, establishing disease prevention policies and improving treatment quality and patient safety sound tough, is the health-care system in Canada and Saskatchewan really that bad?

One problem is that all provinces copy one another, so that they all offer inferior albeit standardized health programs. More regrettable, we increasingly choose to model our system upon the American dream.

So where do we stand exactly? A recent issue of Maclean's had Dead Last splashed on its cover, with the subscript stating: "A recent survey of developed countries puts Canada at the bottom of the list in timeliness and quality of care. What happened to our national dream?"

The reality is that in every recent international review, the Canadian health-care system ranks at the bottom of the developed world in terms of performance, timeliness and cost effectiveness.

In a study from the Commonwealth Fund of developed countries on three global measures, Canada had the least effective care and the worst record for timeliness of care, but had the second highest per capita costs. The top country was the Netherlands followed by the United Kingdom, Australia, Germany and New Zealand.

The Canadian health system had per capita costs of $3,895, while similar countries such as New Zealand and the United Kingdom had costs of only $2,454 and $2,992 per person. To put this into perspective, Saskatchewan has per capita costs of $4,600.

The oddity is that we want so desperately to emulate the U.S. We want to follow its lead of having more hospitals, surgeries, diagnostics, investigations, treatments, and so on. However, the Commonwealth Fund study found that the American system had the highest per capita health-care cost of $7,290, while being at the bottom of the pack for effective care and timeliness of care. Imagine the effectiveness, timeliness and costs of the American health-care system when it extends coverage to an additional 36 million residents.

As a member of the Commonwealth, it seems odd that we are so opposed to modelling our system after Britain, which ranked No. 2 overall. Would it really be so bad to borrow some ideas from Great Britain?

What about other studies? In a recent study from the Organization for Economic Co-operation and Development, Canada had the fifth highest per capita healthcare costs among 32 countries. At the same time, Canada had belowaverage health outcomes in areas such as infant mortality.

In a recent Frontier Centre study, Canada ranked 25th among 34 countries on a wide range of indicators including cost, outcomes and wait times. The study ranked Canada ahead of Slovakia, but behind Portugal.

On the topic of developing countries, I recently wrote a column that compared health outcomes in Canada to Cuba in the Third World. It is perhaps surprising that Cubans spend one-eighth as much on health care while obtaining the same or even superior health outcomes. Without any disrespect intended toward Slovakians or Cubans, it is likely that most Canadians would want a health system that ranks much higher.

Specific to Saskatchewan, the 2008 Patient First Review concluded that our health system has lost its focus on the patient and lost sight of the fact that health care is a service industry. So how do we find our way?

Despite the massive investment in health care in Canada and Saskatchewan, it is perhaps surprising that so many treatment providers are stressed out and frustrated. In my opinion, this is because there are no health outcome goals and objectives to accomplish them.

There is no overarching strategy that addresses and co-ordinates social causation of disease, or provides behaviour modification and evidence-based medical management. It is incredibly frustrating to work in health care knowing that you have such limited impact on the life of an individual, let alone that of an entire population. Quite simply, there are too many non-medical determinants of health that predict poor health outcomes. As such, no one really knows what their role is. Poor outcomes follow.

In Saskatchewan, we have doubled health-care costs over the past 10 years, with every indicator that we monitor worse today than it was a decade ago even after statistically adjusting for age. It is time to start asking tough questions.