Too often, governments are interested in quick-fix approaches instead of the long-term strategies that would actually result in real change, says Dr. Marcus Hollander, a health-policy expert and president of Hollander Analytical Services Inc., based in Victoria. The health-care system is still designed around acute conditions, like broken limbs and heart attacks. The refusal to evolve to treat the chronic, complex patients who currently take up the lion’s share of hospital beds is exacerbating illnesses, contributing to unnecessary deaths and costing the system inordinate sums, he says.
“What I’m seeing now, at a systems level, is an escalating cost spiral that we’ve self-induced,” says Dr. Hollander, who has a PhD in human and social development.
Health-care funding in Canada can be complex, with provincial and federal governments each playing a role. But there’s nothing stopping any of them from delivering community-based care.
Instead, however, the current fixation is on piecemeal initiatives, like earmarking more money for home care. But this, according to Dr. Hollander, simply adds to the health-care bill because it creates parallel programs while leaving inefficiencies that are causing so many backlogs in hospitals.
“Putting more money into home care is basically an add-on cost,” he says. “The only way you can have any more money and make the overall health-care system more efficient is if you set up these integrated systems using integrated models of care.”
When Dr. Hollander worked in the B.C. Ministry of Health in the 1980s, he was a driving force behind the creation of just such a system. The government froze construction of new hospital beds and focused on delivering care outside of the hospital as a way of preventing illness and keeping people with chronic disease at home for as long as possible. The program worked well; in a 10-year period, he estimates the province saved about $150 million.
But the program was dismantled during budgetary crises in the 1990s when the provincial government turned its focus to what Dr. Hollander describes as “quick fix” remedies for saving money, such as cutting home-care funding for everyone except the gravely ill.
Today, there are examples of community-based care initiatives, such as those pioneered by Drs. Turnbull and Fleming, emerging across the country. The problem is they are a patchwork of different approaches lacking a cohesive, system-wide vision that could lead to wholesale change and produce better patient outcomes and significant cost savings.
Adel Doss is back home now, but his sister says he is worse than ever and worries about how long it will be before he has to return the hospital.
“We would like more support,” Minerva Doss said last fall while visiting her brother at Sunnybrook. “But the way the system works makes you feel down and…just [want] to give it up.”
Carly Weeks is the Globe’s health reporter. With files from André Picard.