Sommes-nous vraiment prêts pour une réforme de la santé?
Are we really ready for health reform?
As with most of you, I have been anxiously awaiting the health policy report by Don Drummond that was commissioned by the C.D. Howe Institute. And the report entitled: Therapy or Surgery? A Prescription for Canada’s Health System, was released in November and has already sparked some very interesting conversations in healthcare. Drummond adeptly assesses the Canadian health system and is clear in his review that the current delivery methods are not effective and are too costly. He points out the obvious misalignment between healthcare cost increases and the ability of the tax system to support these increases. This is not new information for most of us in the system. For some time, health administrators and analysts have identified sustainability of the current system as a significant issue – and Drummond acknowledges that we have been sounding the alarm in this regard. In his assessment he, of course, arrives at the appropriate conclusions in terms of the disproportionate emphasis on treatment of symptoms of bad health, lack of implementation of cost effective treatments, pharmacare prices, rationing and limiting scope of public coverage. Succinct and insightful analysis of “the problem” in terms of our national healthcare system, however, was not the most compelling part of the report in my opinion.
The fresh view presented in this report rests in two major theme areas. The first is in terms of the public attitudes respecting the health system, and the second is the fix for the system that Drummond advances.
On the notion of public attitudes, the point is clearly made and is supported by polling data that despite the inefficiencies and gaps in services in healthcare, people are prepared to pay more for health services. The discussion is framed from the perspective of health services being viewed as a “luxury” and taxpayers being prepared to pay more for the service. This information is interesting given the large proportion health already represents in terms of overall provincial budgets. It also leaves one with the question of the public’s attitudes on tolerance for shifts in the current “status quo” within health services. Public sentiment is always a significant factor or variable in relation to the efficacy of change in healthcare. And reform is essential from Drummond’s perspective. In a nutshell, he challenges the provinces and territories to issue longer term health plans, describe the health challenges from a demographic perspective, set objectives, discuss the financial matters and lay out a plan for meeting objectives. He also emphasizes the need to shift the system from acute to chronic care and health promotion and prevention.
The really interesting part of the report for me lies in the cautions presented around previous strategies to reform the system. The nineties and the removal of resources during this time period without any ties to meaningful health reform is cited as a mistake we don’t want to repeat. Instead, there is a thoughtful commitment to the notion of driving change through enhanced accountability and integration in the system. Meaningful change that happens at the level of the client/patient and results in enhanced quality of services.
Some may read this approach as a recipe for “incrementalism” or an approach that is not aggressive enough given the current economic context. However, I read the recommended approach as a challenge to healthcare leaders in Canada to drive the change in the areas noted, reposition programs and find the solutions within the system.
No doubt, the messaging in Therapy or Surgery? A Prescription for Canada’s Health System will find its way to the provincial and territorial discussion on the renewal of the Health Accord and will also form a significant part of the report that Drummond tables with the Ontario government early in 2012 in his capacity as Chair of the Commission on the Reform of Ontario Public Service.
The stage is being set for a new type of health reform in Canada that requires significant leadership and vision. Are we up to the challenge? Write us with your thoughts on the subject.
Kevin Mercer, MA, FCCLS
