A followup to the May 26 discussion on Ageism: ARE YOU GETTING PROPER MEDICAL TREATMENT WITH YOUR DOCTOR?
Doctors’ offices having signs telling patients to expect treatment for one ailment only on any given visit. Senior patients have been labelled as GOMERs (Get Out Of My Emergency Room).
Now a Toronto Star contributor comments about the need for changes to health care in Canada.
Alexis Wise s a health advisor and senior manager with the MaRS Centre for Impact Investing. Alexis’ current work focuses on issues related to health system innovation, policy levers for influencing behaviour change, healthcare contracting and pricing mechanisms, and measuring outcomes and impact.
Here is what she wrote in the Toronto Star, June 4th:
We must change the way we pay for our health care
Health care costs the public sector about $160 billion a year in Canada, a higher per capita cost than most industrialized nations. Yet Canadians are not markedly healthier, nor do we receive better care.
The Commonwealth Fund has ranked Canada l0th out of ll developed nations for the efficiency of our health care system (only the United States was worse). We came at or close to the bottom in access to care, timeliness of care and overall quality of care, and didn’t rank in the top three in any of the metrics reviewed.
Maybe our healthcare system isn’t as great as we like to think it is. How can Canadian health care move to the front of the pack?
Part of what holds us back is how public health care spending is allocated. For example, the way we spend health care dollars is often process- rather than outcomes-oriented.
Most provincial governments pay health care providers, at least in part, according to the tasks they’ve performed rather than the outcomes they’ve achieved.
Doctors, too, are often paid, at least in part, by the number of patients they see or activities they perform with little consideration given to the quality or appropriateness of care delivered.
A system that encourages improved quality and access to care, providing the best possible value for public spending, and rewards innovation may be what’s needed.
The outcomes that matter to many patients – a good care experience, the highest quality of life for the longest time possible – could be how success is judged.
Financial incentives that reward care providers for helping to keep their patients healthy would encourage innovation in valuable areas of health that historically have been difficult to build a business case around, such as health promotion and disease management and prevention.
How do we get there?
Governments can’t mandate innovation, but they do have levers they can use to encourage those who want to experiment and innovate.
Setting a forward-looking national vision for change would provide a powerful signal that the status quo is not in the best interests of Canadians.
Some interesting funding experimentation is already taking place.
In Mississauga, Trillium Health Partners and Saint Elizabeth home care have agreed to be paid jointly by the province based on how well cardiac patients do after leaving the hospital:
After a year, the results are promising. Patients are being discharged sooner and post-op readmissions to hospital and emergency department visits are down. New Brunswick is implementing new ways to deliver better health care in the community. Medavie Health Services, a private provider of emergency medical and community care services, will soon enter into a performance-based contract with the province. Its reimbursement will be linked to metrics related to increased system capacity, improved patient experience and improved population health outcomes.
And the federal government recently unveiled Canada’s first social impact bond in health to pay for a blood pressure control program run by the Heart and Stroke Foundation with support from MaRS Discovery District and its Centre for Impact Investing. The payments Heart and Stroke will receive will vary according to how well it can control participants’ blood pressure.
These experiments are vital first steps, but the scale of ambition needs to be much greater for meaningful transformation.
Canada needs a national outcomes measurement and health funding strategy, in partnership with the provinces and territories, with a substantial commitment to test new approaches and adopt those that work. A federal support and evidence collection unit could provide expertise in funding innovation for provinces and health care providers seeking to test new payment approaches and allow others to learn from those who have already done so within Canada and internationally.
We need to shift our focus to understand how to drive the best health outcomes and get better value from limited health dollars. Governments and care providers must strategically experiment with ways to pay for care that align health stakeholders to seek better quality and value. This is the future of health care.
Source: Toronto Star, June 4.
Alexis Wise is a contributor withEvidenceNetwork.ca and a senior manager at MaRS Discovery District.
Our response to Ms. Wise:
Wise has numerous solid examples as to how health care costs can be reformed and improved. Her examples about incentive financial support to hospitals and patient centres as in Mississauga and in New Brunswick are very noteworthy.
The federal government initiative relating to better control of blood pressure problems is also very commendable.
However, Ms. Wise misses the real target in the problem of health care costs in Canada. Politicians and government ministers have to have the chutzpah, the energy and the motivation to go after change in more dynamic ways than they currently do. Some very obvious changes to health care would incur minimal government costs but the initiatives need to be taken by the government. Solutions offered by regular citizens do not move the bar one iota. The government should be exploring ways where medical professionals could be supported by semi-professionals. For example, dieticians and nutrionists could work in conjunction with doctors to teach and coach patients about improved nutrition; physiotherapists and chiropractors could work as support staff to doctors whose patients need physical therapy. Why are these kind of reforms not be examined and initiated in small steps to see their impact on health care. Surely a yoga practitioner or a mindfulness therapist could be a concrete support staff to a doctor and they would cost less the the doctor.
On another note, again pounding the drum loudly, seniors must take some initiative themselves or do so through family members batting for them. Demand full care; do not accept treatment which is less than what is called for; doctors who treat seniors in a lesser way than they should because of the patient’s age are acting in a hypocritical way rather than their sworn Hippocratic way.
