If you gave so-called "ordinary Canadians" the opportunity to have a thoughtful, informed discussion about the state of health care and asked them for recommendations on how to sustain and improve the system, what exactly would they come up with?
PricewaterhouseCoopers (PwC) Canada, a giant accounting and consultancy firm, decided to find out. They created a "Citizens Reference Panel" of 28 representative Ontarians, gave them some basic information and technical support, and sat back and watched.
The result is a fascinating and eminently sensible 45-page report entitled "Public Priorities for Ontario's Health System."
The adult conversation we need to have about health care has not occurred, in large part, because politicians, policy-makers, experts and pundits have largely cast aside the public. Rather, they have bored us to death with rhetorical and contradictory platitudes like: The system is unsustainable; all we need is more money; privatization is our salvation/doom; we're a lot better than the U.S./a lot worse than Europe; and so on.
The Chicken Littles and rose-coloured-glasses wearers alike would do well to read the new report, which is refreshingly short on grand pronouncements, opting instead for practical solutions.
To use a glib analogy, imagine that the garage has become so cluttered that you can no longer park a car. The response of our health-care leaders would be to build a bigger garage and then go looking for a new car worthy of its surroundings; the response of this citizens' panel would be to get rid of the clutter, and maybe get a smaller, more fuel-efficient car for good measure.
But back to the report. First, let's look at what the panel didn't recommend. They didn't say the health system needs more money. Nor did they say it was unsustainable. They said we should make do with the health dollars we have now - in the same way families have to live within their means.
The central message of the ordinary tax-paying folk is this: We don't need to shovel more money into the current system; we need to innovate to make the system more efficient and cost-effective.
The citizens had very little to say about how the system is funded or who provides services (government, non-profits, private enterprise). Instead of being sucked into the interminable private-public debate, there is a tacit acknowledgment that there is a mix of private and public funding and delivery now, and the sense that whether we pay for care from the left pocket or the right is of little import.
What matters, the panel members stress, is that essential health care be accessible and affordable to all, and that is the focus of their 13 recommendations:
The health system is enormously complex and when patients are sick/injured/demented they are scared and needy. Chief among the needs of patients is having a navigator oversee their care and answer their questions.
2. Access and timeliness
Health care delayed is health care denied. The citizens' panel says this is a priority but we need not throw more bodies at the problem. Rather, make better use of existing resources like nurse practitioners (particular in ERs), centralized specialist referral, etc.
3. Patients as partners
Patient-centred and family-centred care should be more than PR slogans; they require a cultural shift. "Patients need to be empowered as active and knowledgeable partners in the health-care process."
4. Primary care
Access to primary care is inadequate and inefficient. Basic needs should be provided by nurse-practitioners in addition to doctors, and incentives should be offered to get practitioners into rural and remote areas.
5. System integration
Information-sharing and communication are mired in the Stone Age. The panel wants electronic health records now, and expansion of health information lines such as 211.
6. Information sharing and eHealth privacy
While eHealth records are essential, there needs to be assurances the data are secure. Patient records should also be freely available to patients.
7. Accountability and incentives
Our current payment methods reward volume not quality. The panel wants to see new funding models for health-care professionals that link compensation to measurable patient outcomes and patient satisfaction.
8. Community care
There is too much inappropriate hospitalization and institutionalization, particularly of elderly citizens. The panel wants to see a massive shift to community-based services.
Excellent communication is a hallmark of first-class care. But patients don't always receive the information they need or understand.
10. Language barriers
In multicultural Canada, more needs to be done to serve patients in their first language. There also needs to be more plain language and less jargon.
11. Disease prevention and health promotion
Investment in prevention is inadequate. The panel says all sin taxes (alcohol and cigarettes) should be spent promoting healthy lifestyles. In particular, they call for mandatory nutrition and phys-ed classes for students in kindergarten to grade 12.
Access to prescription drugs is uneven, making treatment unaffordable for some. The citizens' panel recommends a pharmacare plan, but one where drug costs are kept down with bulk buying and other measures.
13. Mental health and addiction
There is a need to reallocate funds to mental health, particular prevention programs and making addiction treatment more affordable.
All in all, a sensible, do-able package, and proof that the public knows full well what needs to be done to improve and sustain medicare.
What is still lacking is action, and leadership.
To view the report go to: www.pwc.com/ca/en/healthcare/citizens-reference-panel-ontario-health-services-report.jhtml