Thursday, March 29, 2018

The Eternally Valid Health Care Solution

I've solved the health care system, now and for all time.


In an ever-changing world, it's getting harder and harder to keep up with what's new and important in health care. There are always changes in government, deadly outbreaks, and shifting political winds around every corner. Fortunately, all is not lost. For you, my dedicated readership, I have spent countless hours, researching and engaging to identify all the key issues in the health care debate. I offer this summary, both to bring you up to speed, and more importantly, present a visionary blueprint for the best way forward. This might be the only essay you will ever need to read about health care.

The Eternally Valid Health Care Solution

Universal health care represents a core, cherished Canadian value. But the health care system is all too often disconnected from the very real needs of the patients it serves, and fails to make optimal use of its resources, resources that take up an ever-increasing share of government budgets. Canada's health care system, in fact, is largely made up of a patchwork of programs and services delivered from within silos, burdened by top-heavy bureaucracy that is out of touch with the needs of patients, and fails to address concerns of front-line workers. There is plenty of evidence that this generates waste and may contribute to burnout.

In order for the health care system to truly meet the needs of the population, policymakers and leaders need to break down these silos, and recognize it's the patients that matter most. Let's move away from hospitals and politicians making all the important decisions, and recognize that a community-driven, patient-centered health care system will be the key to moving the policy discussion forward.

The starting point for any discussion is that Canada's health care system came to life in the 1950s and 1960s. We cannot meet the needs of a rapidly aging population with an insurance scheme that dates back to the middle of the 20th century. What Medicare was designed to cover - doctors, hospitals, and medical diagnostics like x-rays - is simply not appropriate to meet the health needs of the present day. We need to re-examine our priorities and modernize our definition of comprehensive coverage, in ways that might even realize real savings.

A modern health care system starts and stops with integrated primary care, where the patient is the center of attention by a multidisciplinary team of health care providers. We know that investment in multidisciplinary primary care is cost-effective, reduces potentially harmful hospital stays, and results in more satisfying long-term relationships between the patient and his or her health care providers. When we use key indicators mined from electronic health records, we can leverage the power of modern information technology to foster a culture of continuous quality improvement.

But patient-centered medicine has a second meaning in modern times, driven by advances in medical technology. Our ever-expanding knowledge of human genome, precision medicine and targeted biologic therapies, safer and higher resolution diagnostics, less invasive and robotic-assisted surgeries...all of these will bring about myriad benefits to patients, but we can never forget the human side of medicine. Sometimes a caring touch is more therapeutic than all the pills and procedures scientists can dream up. We must, as a nation, ensure that our health care providers prize a generalist approach to medicine and health care, healing with the heart as well as the scalpel and prescription pad.

Yet this is still not enough. For too long, we've equated health and health care with medical care. Canada has been at the forefront of recognizing the role of education, income, housing, and other Social Determinants of Health. It is past time that Canada geared its policy process towards addressing Social Determinants, as part of a comprehensive public health policy package, that monitors the population and its burdens of illness, keeps alert for new and emerging threats, and makes targeted investments in social equity to improve the health of vulnerable populations.

None of this can come at the expense of our most precious resource in health care, the dedicated professionals that put in years of hard work and sacrifice to get to where they are. We must have a nimble, flexible, and comprehensive health human resource strategy, to prevent our excellent professionals from burning out, and to ensure we have the right people with the right skills in the right place and on the right team. The health of the population depends on it.

And of course, we must always remember that a healthy population is driven by a healthy economy and a sustainable tax base. In the context of demographic change, we must bend the health care cost curve to put our treasured national system on a sustainable fiscal footing. There might be trade-offs in the days ahead, but we can always find efficiencies, create value for money, and reduce unnecessary waste. We can and must be effective stewards of taxpayer dollars. Experimenting with novel payment models and building on success is a must.

All of this will demand hard work, leadership, and political will. But the notion that health care is the third rail of Canadian politics is something Canadians should not accept and cannot accept. Our health and our children's health cannot afford to wait!

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