Just over a year ago, Health Minister Rona Ambrose announced, with some fanfare, the creation of the Advisory Panel on Healthcare Innovation.
The blue-ribbon group, led by Dr. David Naylor, former president of the University of Toronto, was asked to recommend the five most promising ways the federal government could support innovation in a manner that would both improve accessibility and reduce costs.
The move was widely seen as a token gesture by Ottawa to show it was interested in health care when, in fact, it has disengaged to the point of doing little other than cutting cheques for ever-diminishing transfers of health dollars to the provinces.
Critics assumed the right-leaning panel would behave Dragons' Den-like, embracing a handful of showy private sector innovations and deliver a kick in the pants to the proponents of socialist medicare.
What it delivered was something else entirely – a nuanced examination of the barriers to innovation and a sharp rebuke of governments for their lack of commitment to keeping medicare current and relevant.
This is not what the Harper government wanted to hear, so it released the report on a late Friday afternoon in summer, hoping it would be ignored.
But the Naylor report is a must-read for anyone who cares about the future of Canada's health-care system.
It is loaded with stinging truths, beginning with "medicare is aging badly" and a "major renovation is overdue," and stressing that despite our being blinded by pride, the publicly-funded health-care system provides coverage that is inadequate, slow and costly; performance is middling at best.
The report also features a decent "to-do" list of where to begin the renovations, with its mandated five point list:
- Embrace patient engagement and empowerment;
- Integrate fragmented health systems and modernize the workforce;
- Invest in technological transformation, namely digital health and personalized medicine;
- Get better value for money by improving procurement, reimbursement and regulation;
- Partner with industry as a catalyst for innovation.
There's nothing new here, and that's not a knock on the panel. What needs to be done to modernize medicare is no secret; how to do it is the challenge.
This is where the insight of Dr. Naylor and his cohorts is most evident and useful.
The panel says, essentially, that you will never get meaningful innovation without real commitment and lambastes governments – and Ottawa in particular – for its lack of engagement.
Dr. Naylor and his team stress that Canada's health-care system is rife with innovation and creativity but initiatives worthy of emulation are not being embraced and scaled up by make-no-waves policy-makers.
By clinging to the status quo – the path of least political resistance – governments have created an outdated system that is ill-prepared to deal with fundamental shifts like patients demanding more engagement and the impending arrival of personalized medicine.
In the end, the panel states the problem – and the solution – in the stark language of business: There is no system-level innovation in health care because there is a lack of working capital, an absence of expert management and little incentive for or investment in improvement.
In short, there is no business plan, no goals.
The panel bemoans, quite rightly, the lack of federal-provincial co-operation, saying it is "chagrinized and puzzled by the inability of Canadian governments to join forces" in the best interests of patients.
But it saves its most stinging indictment for the federal government.
In the quick reporting after the report's release late Friday, most attention was focused on the call to merge three existing federal funded groups to create a federal Healthcare Innovation Agency of Canada, with a budget of at least $1-billion annually.
But what the Naylor report is proposing is not the old fallback position of simply spending more to do the same. In fact, it deliberately avoids saying anything about federal spending or health transfers.
Rather, it calls for a new philosophy, one that involves Ottawa having ideas and taking action beyond cutting cheques; to quote: "...a different model for federal engagement in health care – one that depends on an ethos of partnership, and on a shared commitment to scale existing innovations and make fundamental changes in incentives, culture, accountabilities, and information systems."
Stated more colloquially, if the next prime minister – whether his name is Harper, Mulcair or Trudeau – wants medicare to actually meet the needs and expectations of Canadians, he needs to put on his big-boy pants and lead, not lie down, and innovate, not just pontificate.
André Picard is The Globe's public health columnist.