Health care transformation falling short

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It’s hard to believe 2013 is coming to a close. With the ending of another year, we often find ourselves reflecting on the good, the bad and what we want to do better for next year.

For Canada’s health care system it was a year of transformation – something that seems to be the norm nowadays.  And that’s a good thing. With changing demographics within our population, an abundance of new technology, and access to more information than ever before, transformation is a sign that we are moving forward.

As the editor of a health care publication I often find myself drawn to conversations about healthcare.  Over the last seven years I have noticed there is only one thing Canadians like to talk about as much as the weather and that’s their most recent experience in our health system. What I find particularly interesting is the transformation I have noticed in these conversations.

As recently as three years ago most conversations I overheard or took part in, inevitably turned into a rant about how terrible our system is. A friend who couldn’t find a family doctor, a neighbour who had to wait 10 months for a hip replacement, an aging and frail family member who was unable to find long-term care. Very rarely did anyone have anything good to say, other than, “At least it’s free.” Which was always met with:  “You get what you pay for.”

What I have noticed is that the negative conversations about our health system are more often interspersed with stories of good experiences – a neighbour whose mother received outstanding end-of-life care, an acquaintance whose young daughter was diagnosed with cancer and received chemotherapy the next day, a friend whose infant had croup and was in and out of the emergency department within two hours. This is encouraging.

This month Hospital News highlights many successes of our hospitals over the last year:  The first Canadian single site gallbladder removal surgery (pg. 14), shortening the hospital stay for prostate cancer surgery patients (pg.18) , a new tumour bank that will bring breast cancer discoveries to the bedside more quickly (pg.23), and the list goes on.

Without question, our system is transforming. In some areas, efficiencies are increasing as we adopt new technology and streamline care. Transparency is increasing and patients can now see how their local hospital is doing on a number of performance indicators (cover story).  Measurements are being implemented to find areas where efficiencies can be further improved. Huge strides are being made. But it’s not enough.

Numerous associations, health quality councils and health leaders have sounded the alarm. Change needs to happen at a much faster pace, and a much larger scale.  A recent Health Council of Canada report ‘Better health, better care, better value for all’ indicates that with some exceptions, changes to healthcare have not kept pace with the evolving needs of Canadians. In fact, our health care system is not as good as we think it is.

The reality is troubling. In spite of being one of the top spenders on healthcare (internationally), when compared to other OECD countries, we aren’t doing all that great of a job.

According to the report, Canada ranks near the bottom in areas like wait times for elective surgeries, being able to get a timely appointment with your family doctor and electronic health records (EHR).

Ten years ago the health accords were developed (with a huge increase in funding) to improve healthcare – and timely access to it across the country. Here we are 10 years later and 25 per cent of Canadians still report waiting over four months for elective surgery (compared to 33 per cent in 2005). Canada ranked last of 11 countries – Germany ranked best at zero per cent.

Most Canadians who are sick and call their family physician can’t get an appointment with their family doctor that day or the next day.  At 47 per cent, Canada ranks last out of 10 countries in primary care doctors providing same-day or next-day appointments – France ranked best at 95 per cent.

What’s more disturbing is that in 2004 14 per cent of Canadians reported not having a family doctor – in 2010 that number had risen to 15 per cent.

It’s mind-boggling that every Canadian doesn’t have an EHR. In Ontario, a special agency was created to do this in 2008! After a huge scandal and an auditor’s report revealed $1billion dollars in taxpayer’s money was wasted – here we are nearly six years later and only two in three Ontarians have an EHR and only 57 per cent of Canadians.

Long wait times cost the system more money in extra care while patients are in cue, not having access to a physician in a timely manner usually results in an expensive visit to the emergency department, a complete misuse of resources. If every Canadian had an EHR – it would further streamline care and prevent unnecessary and duplicate diagnostic tests, saving money in the long run.

The changes in care Canadians received over the last decade have fallen short. While many of us are having improved experiences in the health care system, the reality is that we don’t know any better. We know that compared to ten years ago in many areas, we wait less and receive more efficient care. But we aren’t getting our money’s worth. As long as we are willing to accept the status quo, we won’t see the transformation required to ensure our system is sustainable and there when we need it.