Canadians associate their health care system with national pride. However, this pride does not match the results delivered by the system. Canada does not have, as many Canadians still incorrectly believe, “the best health care system in the world”. Despite increased investments in health care over the past decade, Canada has not been able to improve its performance compared to other countries. And more worrisome, performance in key indicators, like infant mortality and mortality due to diabetes has deteriorated. Jeff Turnbull, former president of the Canadian Medical Association, noted last year in a public discussion that health care is a foundational pillar of Canada but “the foundation is eroding below us’’.
There is overall agreement that a transformation is needed. However, the pace of change is painfully slow. The Conference Board of Canada’s first-ever Summit on Sustainable Health and Health Care made evident that we need to face some inconvenient truths if we are to make progress transforming health care in Canada. The current system, designed in the 1960s, is ill-equipped to efficiently support delivery of modern health care services. We are attempting to deliver current services within the constraint of outdated physical infrastructures, models of care and labour contracts and inadequate technologies.
As a result of all these shortcomings, our hospitals have been left with the task of not only providing the acute care services they are intended to provide, but also primary care, rehabilitation, and to a certain extent, even long-term care. It is well known that seniors often occupy alternative level of care beds (hospital beds allocated to patients who are ready for discharge but are waiting for placement in home or residential care). A new report from the Canadian Institute for Health Information found that 54 per cent of seniors occupying these beds are waiting for residential care. This situation has overloaded our hospital capacity to provide services, keeping our emergency rooms crowded and adding to high health care costs.
The recent Conference Board briefing The Inconvenient Truths about Canadian Health Care identified four priorities that will help to get the health care system out of the emergency room. These include:
Build a more transparent and accountable health care system with respect to goals, management, and performance. Health care should put less emphasis on counting transactions and interventions, and more on knowing whether these interventions make a difference in patients’ lives. Improving the quality of health care services and increasing value for money requires a fundamental transformation in the culture, compensation models, incentives, and working practices of health care providers and administrators. This shift in culture and practice should be supported by measuring outcomes and establishing accountability frameworks tying these outcomes to performance targets. Creating greater transparency and accountability in a properly configured system will go a long way in mobilizing support for changes among all stakeholders—patients, taxpayers, and care providers.
Fix the gateway to the health care system. Primary care, not the emergency room, should be the first contact point within the health care system. Aging and growing chronic disease prevalence have changed the demand for health care services. This new demand can be addressed more appropriately and cost effectively in primary care. There is a strong consensus that inter-disciplinary family care teams should be the standard model for primary care and these teams should be expanded and strengthened in all provinces and territories. Primary health care providers should be equipped, tasked, and accountable for delivering effective chronic disease management, as well as encouraging and supporting health and wellness among their populations.
Invest in technology. More intensive and standardized use of information technology would allow providers to collect, record, and share clinical information, which would lead to more efficient treatments and increases in health care system productivity. Progress on applying information technology more widely within the health care system has been stifled by sup-optimal strategies to engage health providers in the uptake of these technologies. Providers need be more involved to speed up change and adoption. Greater use of tele-health technologies would allow patient monitoring from home or community-based practices and would decrease the need for hospital services.
Align the health care system with the needs of an aging population. Hospitals are risky places, particular for seniors who are more vulnerable to infections, and who don’t cope well with limited mobility and disruptions in their routines. Health care transformation in Canada needs to include effective models to provide access to appropriate geriatric, psychological, and physical care, as well as the behavioral, social, and healthy living support required to maintain seniors’ independence and safe living at home.
The required transformation will not be possible without a true interprofessional dialogue and participation of patients and families. Everyone needs to engage in an open-minded dialogue and come to the discussion table—not to defend their own interests, but to advance the interests of patients and their families. Time is of the essence. Let’s move from rhetoric to action.