In recent days, Canadian Blood Services has announced that it was closing three permanent blood donor clinics, discontinuing mobile blood donor clinics in 16 communities and axing its bloodmobile program.
This is great news.
Blood collections facilities are being trimmed because less blood is needed. Less blood is needed because it is being used more appropriately and because of advances in surgery.
In Canada, "cutbacks" in health services, no matter how trivial or sensible, usually elicit a predictable response: An angry proclamation that the service is essential, a loud bemoaning that medicare is being undermined and on the verge of collapse, and a dire warning that countless people will die gruesome deaths due to our uncaring ways.
But we rarely celebrate sound administration, efficiency and better, more appropriate care.
If you think about it, the ultimate goal of a health system should be to put itself out of business, to ensure that everyone is so healthy that they don't need medical care.
As a publicly-funded health insurance system (medicare), efforts should also be made to ensure taxpayers get the most bang for the buck for the money that is invested in delivering health care.
There is not much evidence that either of these aims is a priority.
Total health spending in Canada this year will be an estimated $215-billion. Only about 5 per cent of that is spent on prevention, some $11-billion.
The vast majority of our health dollars go into patching up sick people, not keeping them healthy; it should rightfully be called a sickness care system.
Still, we deliver good sickness care in Canada, at least when you're in the right place. Access to care is another matter, as is cost-effectiveness of the care that is delivered.
Time and time again, studies have shown that somewhere in the neighbourhood of 30 per cent of care is of no benefit (or, in some cases, actually harmful) to patients. If you do the math, that's almost $65-billion worth of wasted dollars annually.
There is no simple explanation for why this happens, but there are some troubling practices that perpetuate the waste. We have a largely procedure-based payment system; practically, that means the more physicians, pharmacists and hospitals do, the more they are paid. Generally speaking, payment is based on volume, not outcomes.
We tend to embrace the mistaken notion that more is better, and this leads to overtreatment. The oft-repeated anecdote of a 90-year-old with terminal cancer getting a hip transplant is the extreme example.
Finally, there is a lot of turf protection and ingrained conservatism in the health system. We clamour for new and better drugs and treatments, but stubbornly resist ever getting rid of less effective and efficient ones. Nobody ever wants their piece of the pie to get smaller, only larger.
In short, the structure of our health insurance and delivery system encourages quantity over quality and appropriateness.
There are now initiatives like Choosing Wisely Canada, that aim to tackle some of these problems by urging the elimination of unnecessary tests, treatments and procedures. But the recommendations tend to be more timid than revolutionary, more marginal than transformational.
The only thing that seems to bring about significant reform is catastrophe – which brings us back to the story of Canadian Blood Services.
CBS rose from the ashes of the Canadian Red Cross Blood Transfusion Service, which essentially went bankrupt after the tainted blood scandal. For those who don't recall, about 2,000 hemophiliacs and another 20,000 transfusion recipients contracted HIV-AIDS and/or hepatitis C from blood and blood products, due to bureaucratic bungling, incompetence, poor regulation and lack of accountability and transparency.
When the blood system was rebuilt, it was done thoughtfully, based on the recommendations of Mr. Justice Horace Krever, who headed a royal commission into the tragedy. The disaster also led to a re-thinking of how blood and why is used.
One of the saddest of all the sad stories of tainted blood is that of a Toronto newborn who was given a "top-up" of a single teaspoon of blood to put a little colour in his cheeks, just weeks before universal testing was instituted. He ended up with HIV-AIDS.
Today, the amount of blood transfused into patients has dropped substantially because of better practices and technological advances – an impressive 14 per cent drop over the past six years. There is also extra vigilance in ensuring the safety of blood products, and the result is the blood-borne infections are virtually non-existent.
CBS has also become a model of how provinces can co-operate to deliver health care more efficiently and cost-effectively. All blood products – the drugs that are manufactured from various components of blood – are purchased jointly through a tendering process, which has resulted in savings of about $600-million over five years. (Imagine the benefits, if this model was used to purchase all prescription drugs, a bill that now exceeds $30-billion a year.)
Additionally, because it is run as one cohesive organization (rather than a bunch of silos, like most healthcare institutions), CBS can make sound business moves like closing blood clinics for efficiency, and largely free of the political considerations that permeate most decision-making in healthcare.
What we tend to forget is that an efficient, cost-conscious health system is a safer, better health system.
It shouldn't take a debacle like tainted blood to get us to act on that knowledge.
André Picard is The Globe and Mail's health columnist.