By Mary Ackenhusen
Canadians need a wake-up call about the state of our health care system and the fact it will not sustain us into the future. With an aging population, soaring costs, outdated compensation models, and a history of lackluster investment in technology, we can no longer be complacent about that in which we once took so much pride.
Multiple studies show that the growing cost of our health care system only produces average outcomes and our health care spending – which is about 40 percent of the provincial budget in British Columbia – is squeezing funding for other important investments that we know are major contributors to population health: education, housing, social programs, economic investments, and infrastructure. In other words, the cost of maintaining the status quo in healthcare is slowly eroding virtually everything else we hold dear in this country.
And yet, beyond Canada, there are systems that provide superior service at lower cost. Across virtually every comparison cited in a recent Commonwealth Fund study of OECD countries, the US is at the bottom – 11/11 – and Canada is usually 10/11. In 2016, we were ninth comparing cost, access and quality.
I believe this is because our system today rewards volume of care, not quality, patient experience, or responsible stewardship. So care is being provided, but not necessarily in a way that we can hold on a pedestal of “best practice”.
We are heavily invested in a health care system we cannot afford, and in many ways the system is resistant to change. We default too easily to acute and residential care because community alternatives are difficult to engage – even ones within our control. But change is possible – and essential.
To bring our system to the 21st Century and deliver comprehensive care for a growing population of older people – as well as an emerging population of tech-savvy younger people – we need new operating models, data-enabled care, and options for patient-led care facilitated through technology. We must advance big data platforms for personalized medicine, flexible diagnostics, and predictive medicine.
Around the world, it is recognized that healthcare can be delivered more effectively and less expensively in the community so we must expedite our shift away from hospitals to comprehensive community-based care. Instead of investing in bricks and mortar, we can use our valuable (and scarce) resources to improve primary care homes and networks, create urgent care centres, and advance telehealth, with hospital care reserved for acute, episodic needs.
Most importantly, as consumers, we must advocate and pay for what we want. Today, excellence is not rewarded and often quality, outcomes, and patient satisfaction have nothing to do with how a physician is paid. We must compensate for value, not volume alone, and demand investment in innovation that will lead to new models of care and the best outcomes overall.
All of this is within our reach. We can leverage the power and potential of the digital revolution starting with information systems that offer a single electronic patient record so that all providers in all locations have the same picture of the patient. With access to a common health record for all providers, we reduce redundancy, produce automated real-time data, and achieve better-informed, standardized care – and we empower patients by giving them access to their own information.
The tools are already at our finger tips: The smart phone has become a portal to manage much of our lives so why not our health too? In other industries where consumers shift to a leadership position, they call it “democratizing services” and it is our future in healthcare. It is one of many shifts that will allow us to maintain universal access at a reasonable cost, but it can offer us so much more in terms of quality outcomes:
- patients “owning” their information and care;
- predictive analytics that help alert patients and providers to events;
- research that can be enhanced through more and better data;
- mobile diagnostic and health monitoring devices that lead to quicker, better-informed decision-making.
The next big software update for the iPhone will likely include a “Health Records” feature to allow users to view, manage and share their medical records. Certainly there are some concerns about privacy and data sharing, but if we want the benefits and outcomes badly enough, surely we can advocate for solutions on this front as well. This is about thinking bigger and focusing on the possibilities, rather than the barriers.
It is time for public healthcare in Canada to capitalize on the many opportunities for superior care that have been proven out in other jurisdictions. As hard as it is for a monopolistic industry with a risk adverse culture to reinvent itself to meet modern healthcare demands, we have to start now – in fact we should have started yesterday. At Vancouver Coastal Health the change is underway: We are fostering innovation internally, primarily around digital technology and telehealth with support for pilots and commitment to scale-up where we experience early success. We are making a substantial shift to demonstrate – to our staff and to our business partners – that we are open for business and committed to finding solutions for a sustainable public healthcare system into the future. We see the opportunities and we are ready to seize them.
Mary Ackenhusen is President and Chief Executive Officer of Vancouver Coastal Health.