By Neil Fraser
Ontario’s recently announced strategy to expand digital and virtual healthcare over the next couple of years is encouraging for all of us working to create a brighter future for our ailing health system.
The government’s Digital First for Health Strategy promises to introduce more patient access to video visits with physicians, enable patients to book appointments online and improve healthcare provider access to electronic patient records.
These changes will help harness the power of technology to improve the patient experience and make it easier for doctors and clinical staff to provide more timely care. But they are only a small piece of the puzzle required to build a healthcare system that can meet the evolving needs of Canadians, many of whom are living longer, experiencing more cases of chronic conditions, and want to stay in their homes as long as possible.
The stark reality is that Canada — once heralded as an innovator for implementing a publicly funded healthcare system across the country — has been underperforming for years on the world stage when it comes to healthcare.
We have not evolved our system and policies to leverage the technology, talent, processes, and treatments that could both improve clinical outcomes and reduce the overall cost of care.
While several leading healthcare systems outside of Canada are modernizing medical care by providing patients with digital access to medical records, using advanced robotics for surgeries, and enabling big data to better monitor and improve health outcomes, Canada is falling behind.
So, what’s holding back healthcare innovation in Canada?
The bottom line is that the country’s innovation potential has not been realized and one of the key barriers holding us back is the failure to develop and implement policies that support the full innovation cycle from creation through to adoption.
Fundamentally, Canada is ignoring demand-side innovation policies.
Our innovation policies are primarily focused on the supply of innovation – for example, through economic development, such as creating superclusters – which has produced a big talent pool of people who do great research in Canada. But there has been almost no focus on policies that address the demand for the innovations stemming from that talent pool and research.
Demand-side innovation policies recognize that feedback-linkages are required between supply and demand in the innovation process. From a health perspective, demand-side innovation means the healthcare system (that is, federal, provincial and territorial governments) proactively seeking out innovative solutions to respond to a healthcare challenge, rather than the current system where companies with innovative technologies try to sell innovative solutions to the healthcare system.
To create a future where our public policy approach fosters healthcare innovation instead of holding it back, we also need to re-examine the way we cover the costs of delivering healthcare. Our current funding mechanisms, procurement policies and reimbursement methods act as systemic barriers that hold back healthcare innovation.
Canadian physicians continue to be remunerated predominantly through fee-for-service (FFS) payment models. The problem with FFS payment models is that they fail to incentivize the creation of healthier populations and instead incentivize providing services over patient outcomes.
Compounding the problem, the global budgets through which most Canadian hospitals are funded are usually fully allocated by the time they are approved each year, providing little or no opportunity to invest in new technology or processes that would improve outcomes or save money over the longer term.
Ineffective hospital procurement policies also inhibit innovation and weaken healthcare performance, with little accountability for operational efficiency and patient outcomes. Procurement teams too often focus almost exclusively on the lowest up-front prices for products and services, even if a product or service that may be more costly in the short term could ultimately produce greater savings and better patient outcomes in the long term.
A final obstacle that needs to be addressed to spur innovation is the unnecessarily long and complicated process for obtaining reimbursement for new technologies. Unlike in the UK or the US, even when technologies do receive a positive recommendation in Canada, there is no guarantee of funding or adoption. Key examples of insufficient funding despite positive health technology assessments include continuous glucose monitors for use with integrated insulin pumps for type 1 diabetes and transcatheter aortic valve implantation for heart failure, which, if used, avoids open heart surgery. This reimbursement challenge provides little incentive for innovative companies to introduce new technologies to the Canadian market and limits patient access to care that could improve outcomes.
Our healthcare system may be ailing, but the prognosis for the future is good — provided all major players in the health system are willing to adapt and transform to better fit in with the changing world around us and the future of healthcare.