For Don Drummond, the question of whether Canada’s health care system is sustainable is best answered with another question: why would one want to sustain the status quo?
“For the amount of money spent, the system should surely be delivering better results,” says Mr. Drummond, the former chief economist for TD Bank and now chair of the Commission on the Reform of Ontario Public Services and Matthews Fellow in Global Public Policy at Queen’s University in Toronto.
He says the health care system is often described as “unsustainable” because health care costs are increasing faster than government revenue growth. But he cautions that this approach ignores changes that could make the system more sustainable.
For the health care system to become more sustainable, Mr. Drummond argues, it needs to shift from an acute-care model to a chronic-care model and also broaden its scope to health in general including prevention and socio-economic factors that lead to health issues.
But that does not necessarily mean increased spending. In fact, says Mr. Drummond, economic realities mean that provincial governments will soon be compelled to rein in health care cost increases as part of their drive to return to balanced budgets, which means reform of the system is the most obvious solution to the growing challenge.
“The process for reform, in which stakeholders must take a leading role, will be as important as the diagnosis, prognosis and perhaps even the medicine,”
says Mr. Drummond, Chair of the Commission on the Reform of Ontario Public Services
Improving the efficiency and sustainability of the system, he adds, will require a range of actions from organizational and informational improvements, to reforming service delivery incentives and sharpening the focus of health care.
Mr. Drummond believes the necessary reforms can be accommodated under the current public administration or financing model without modifying the general parameters of the Canada Health Act. Specifically, he would like to see better integration of the system around the patient.
“For instance, better value for money could be achieved when high-needs patients, such as high-needs diabetes patients, are closely attached to a primary care practice. Cost reductions, in this instance, might be had from a substantial reduction in hospital costs – the greater the attachment to one primary care group, the lower the overall costs on the health system,” he says.
Peter Barrett, a past president of the Canadian Medical Association, believes the health care system can move towards sustainability by focusing on quality and safety and reducing waste.
“There are still huge variations in what we do and how we do it. Variation is the breeding ground for error; most other organizations know that and try to standardize their activity. We need to do that too,” says Dr. Barrett.
He adds that a focus on evidence-based best practices improves outcomes and quality and saves money.
“Ultimately we will need policy changes to bring about some of these reforms, but a lot can be done without policy changes. If it is good for patients and the system, it seems to me to be a no brainer,” says Dr. Barrett.
