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The times we are working in now need a great deal of accelerated change and there must be no negotiating that down. So my mission statement for this part of my consultancy career is to be clear that there needs to be and will be a lot of change from the work that I do with individuals and organisations and if organisations don’t want that, then it is probably best to go somewhere else.

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Reform and Healthcare in Canada

Filed Under (Canada, Healthcare delivery, Public Health, Public service reform) by Paul on 12-11-2012

I spent last week in Canada talking to people engaged in health care reform in the provinces of Ontario and Quebec. Canada has a socialised medicine system with a lot of similarities to the UK system. The very existence of a socialised medicine system is very important to most Canadians.  Many would say that it is their socialised medicine system that differentiates them from the USA.

Of course this makes our debates about health reform remarkably similar. Last year many Conservatives against reform in England believed that they could always clinch any argument by saying that the reforms being proposed were in some way ‘American’.  Such a charge was meant to end argument and leave those in charge of reform without a hope.

The realities of their neighbour’s health system causes Canadians to be more interested in English reforms because they are so clearly NOT American. They are from a healthcare system whose funding comes from central taxation and where people in need at A and E and not expected to get out their credit cards.

The Canadian economy has not been as badly hit as the UK. Its banks never pretended to bestride the world so they have suffered less damage, but more importantly they are a country of enormous natural resources with a Pacific coastline. That’s a combination that has enabled them to meet the needs of growing eastern economies – and their own economy has grown as a consequence.

So their economic crisis is not as bad as ours.

But they start with a higher % of GDP being spent on health services, and most of it coming from the public purse. They know that the trend of the last two decades has been for health care money to increase annually by a lot more than the increase in GDP, and that has been the normal expectation of the healthcare system.

Intellectually everyone knows that has ended. Their socialised medicine, like ours, is caught in an historical economic and political vice. No political party in either country will win the next election – or the one after – by promising to change the basic funding model of the Health Service. And that means a socialised medicine system primarily paid for out of taxation with no new co-payments. All people who believe in socialised medicine know and feel this is a really good parameter for at least another 12-15 years.

Equally no political party will win the next election – or the one after – by promising to raise taxes. Most people in the health service find this a lot less comforting. But they recognise that their economics needs money to be spent by, rather than being taken away by taxation from, consumers.

So good thing – socialised medicine will be paid for by taxation alone. Bad thing – there will be no new money for a decade.

Equally in both Canadian provinces, and in England, there will be a steady increase in demand for health care over that decade.

This is big history and economics in both our countries. Real leaders on both sides of the Atlantic recognise that if this generation is to ensure the safe development of the socialised medicine system gifted to us by our parents, then they are going to have to make some serious changes to how it operates.

And the most significant of these changes will be – over a decade – to obtain significantly better health outcomes values from the same level of resource. If we don’t do that the public’s experience of socialised medicine over the next decade will be one of cuts and denial of service. So by the third election in the mid-2020s we could have a very different politics with a political party running – and possibly winning – pledged to scrap what will by then have become a discredited system.

Such an outcome would be a failure of leadership for all those who believe in socialised medicine.

So how do we improve value for money?

Whilst I was In Ontario they announced a competition for local health economies to come up with new models of integrated care. They recognised that the current episodic nature of healthcare may have created good episodes of value but that value evaporates because it is lost in failed handovers between episodes. They too have a big problem of increased demand not just for A and E but for emergency beds. One of the figures used all the time is that 1% of the population has 30% of healthcare costs spent on it – and 5% has 50%. Most of this expenditure is caused by the failure of other parts of the healthcare system.

These are mainly, but not exclusively, frail elderly people, but they are also younger people with chaotic life styles.

The Ontarian government want local health economies to come up with patient pathways clearly led by a single institution – and they want them to do this with some alacrity.

They recognise that this is both an improvement in care for the most sickly but is also economically driven. Failed healthcare means that too many people spend their lives going in and out of hospital. Failed healthcare costs much more in delivering this bad service.

They know there is not much time for delay. They must either transform or cut, and they know the long term consequences of a decade of the latter for the socialised medicine system they are stewarding.

Later in the year I will post on what they have achieved with their approach.

Comments:

3 Responses to “Reform and Healthcare in Canada”


  1. I have to take issue with some of what you say:-

    “Most of this expenditure is caused by the failure of other parts of the healthcare system.”
    If this was the case, what is needed is urgent sorting out of the rest of the healthcare system – which would seem to be *producing* demand for healthcare, rather than providing it!
    Can you substantiate this assertion?

    “These are mainly, but not exclusively, frail elderly people, but they are also younger people with chaotic life styles.”
    Again, I’d be very interested in where this comes from: especially the implication that “younger people” (younger than the frail elderly?) who *don’t* have “chaotic lifestyles” are not high users of healthcare: some of them are – and the proportion increases with age, until they slip over the line into being “elderly” – frail or otherwise!

    “The Ontarian government want local health economies to come up with patient pathways clearly led by a single institution”
    This is again something that politicians seem to think would solve all their problems and produce massive cost savings – and is the Kaiser Permenante model of health maintenance organisation.
    KP is profit driven – and keeping costs down helps all parts of the organisation, and covers all conditions: how would you apply this model (which, btw, would appear to remove any Choice from patients) to pathways for individual conditions – which is also the model favoured by this government in the introduction of AQPs bidding for care of a particular condition?
    Would this approach really solve Fred’s problems – now he has become a high user of health services?
    http://primaryhealthinfo.wordpress.com/2011/04/17/what-about-fred-and-his-dog/


  2. […] people commented about the way in which I styled the problem about long term care in Monday’s post. I was claiming that a lot of the expenditure on long term care that ended up in emergency beds in […]


  3. […] people commented about the way in which I styled the trouble about long term care in Monday’s post. I was claiming that a lot of the outgo on long term care that ended up in emergency beds in […]

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