Globe & Mail columnist Jeffrey Simpson gave a brilliant presentation at Idea City last week, calling for an “adult conversation” about improving Canada’s health care system.
Pointing out that Canada spends more per capita than almost any other country in the developed world, and yet gets a level of performance near the bottom, Simpson surveyed a range of possible reforms. But the biggest reform, he suggested, would be to break out of the rigidity of thinking that has characterized past discussions.
Simpson is right. For far too long, Canada’s health care system has been viewed as an untouchable aspect of Canada’s entire identity. The debate, if you can call it that, has been crippled by a false dichotomy – either we retain our system (meaning no private components) or we allow some privatization and immediately wind up with the American system. “American-style” health care is the demon, the bogey man from which we need to be protected. It is as if there were no other alternatives in the world.
Nobody talks about protecting us from “Australian-style” health care or “French-style” health care or “Swedish-style” health care. Yet all of these systems manage to combine private and public health care without life, as we know it, coming to an end.
But we don’t look at these other systems. We’re fixated on a phony equation -“any privatization at all equals Bad, American-style health care.”
I say “we’re” fixated. But there’s some evidence that the fixation may be limited to our politicians and “chattering” classes (with Jeffrey Simpson one of the notable exceptions.) Actual patients may be more open to new ideas – in fact, may already be demonstrating the kind of “adult conversation” that Jeffrey Simpson was calling for.
Price Waterhouse recently put together a panel of Ontarians and asked for recommendations on how to improve the health care system. They were much less worried about funding (public vs. private) and more focused on improvement in delivery. Take a look at their top priorities:
1. Navigation. “The public doesn’t know how to navigate the health care system and access approriate care.” The panel called for more aggressive dissemination of information, helped by the use of multi-media technologies, and by specially-trained volunteer navigators who could provide individualized assistance.
2. Access and timeliness. “There are many inefficiencies in the health system that impede timely and appropriate access to health services.” The panel called for more family health units, exanded use of nurse practitioners in emergency departments, to make triage faster and more effective, and a central specialist referral system to speed up appointments.
3. Patients as partners. “Patients need to be empowered as active and knowledgable partners in the health care process.” This means patients have to be more engaged in evaluation patient-provider interactions “to provide learning and improvement.”
In all, there were 13 areas of concern – from primary care to mental health – but it’s striking how many of the recommendations dealt with better information, faster responses, better integration of resources, more use of up-to-date systems for exchanging knowledge.
As to funding, the panel recommended funding models that are based on accountability. “We endorse linking compensation and other incentives to patient outcomes and satisfaction.”
The report is very encouraging, because it suggests the public have a firmer grasp on reality – including a willingness to talk about what’s really going on – than do our terrified political leaders. Jeffrey Simpson’s call for “an adult conversation” may be met with a much more enthusiastic response than our politicians believe.
You can read the entire Price Waterhouse report here. I urge you to do so.