What’s in the cards for health?

Will it be some tinkering or real change?

“Medicare is aging badly.” This sombre assessment was delivered quietly in the report last June of Ottawa’s distinguished advisory panel on healthcare innovation. One could not read it as, though, other than a pointed wake-up call and affirmation of the concern Canadians feel today about the state of their health system.

But the panel went further, in a message that should strike a chord with governments here as well as alerting the public, as the new government in Ottawa begins to lay out plans for changes in Canada’s healthcare arrangements.

“The panel,” the report said, in reference to its own deliberations, “has been left in no doubt that a major renovation of the system is overdue, and is chagrined and puzzled by the inability of Canadian governments – federal, provincial and territorial – to join forces and take concerted action on recommendations that have been made by many previous commissions, reviews, panels and experts.”

In short, the panel found there’s been little change in the way Canada’s health systems and operations are structured and managed since the days of the 1960s and 1970s when public healthcare was first set up.

In two key recommendations it proposes establishment of a fund with an operating budget reaching $1 billion a year, to pay the costs on the new process.

They could, after all, choose to be bold. And the six-member panel, headed by former University of Toronto president, Dr. David Naylor, has come up with some new and resourceful ways of dealing with healthcare’s shortcomings head on. We are paying a lot for a relatively narrow bundle of publicly-insured services. Although there are many great ideas in circulation and extraordinary pockets of innovative activity across the country, Canada has not been successful in mobilizing large scale change at the system level. Put differently, though it starts many a pilot project, it has neglected to cultivate the good ones, and upscale them, possibly to reach people across the nation.

As its mandates required, the panel names a handful of areas where innovation would make Canada’s healthcare more effective and sustainable, virtually putting the country on a catch-up path with its peers.

Firstly, it calls for patient-centred health care. “The patients want in,” says the panel. Patients increasingly see themselves as partners in their own care. They expect to interact with a responsible system that is designed around their needs.

Second, the panel wants healthcare to respond to the needs produced by Canada’s changing demographics. It points to the coming increase in seniors’ populations, and the need for medical teams that can deal with the chronic illnesses that fill out their lives. Aboriginal numbers are rising fast on the prairies, and healthcare needs will intensify.

The digital revolution is bringing on a range of challenges, involving how and how widely we use and benefit from the data that is already waiting to be collected. And then, for individuals, a potential for smarter clinical decision-making, remote monitoring, health tools and more informed and engaged patients. Coming over the horizon, there will be profound medical changes to be wrought at the individual level through precision medicine.

And then, if the government listens, there could be huge changes at the centre of it all. First of all, healthcare moves into these new processes, not via a set of proposals, to be universally adopted by the provinces and paid for, in part, by federal largesse, but by opening up to the provinces the opportunity to participate through “coalitions of the willing”, involving a shared commitment by provinces and territories, along with stakeholders, medical institutions and others to scale up innovations and make fundamental changes in incentives, culture, accountabilities and more. The initiative could make a meaningful difference to Canadian healthcare in the next 10 years.

As key to the upscaled innovation that is to come in Canadian healthcare, the panel is proposing a mighty agency, possibly at arm’s length from government, which will play a leadership role in fostering the spread of new processes.

Now, as then, this panel lamented in its report, “there is no logic to the existing payments and accountability silos. Healthcare remains disjointed, with poor coordination within and across the various professions, acute and chronic care institutions and community care.”

Stakeholders, said the panel, repeatedly cited fragmented financing as a barrier to the spread of innovative healthcare practices and an impediment to high quality, cost-effective care.

It is no wonder that it takes hard work to make improvements. For a modernized procedure to spread beyond the boundaries of its own unit, these are seemingly insurmountable difficulties. Pioneering health authorities deplored the situation for decades. It explains why Canada has fallen behind many of its peers in the western world in its healthcare offerings.

For a nation currently cheered by the promise that its new federal government will bring in “real change” the panel touches a chord. And the Naylor report, in a series of proposals that would, over a period of time bring Canadian healthcare practices up to modern-day standards, points the way.

 

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