A version of this commentary appeared in the Toronto Star, Hill Times and the Calgary Herald
Should we baby boomers be feeling guilty now that everyone else seems to have finally clued into the developed world’s worst-kept secret: there are lots of us, we didn’t have enough children of our own to replenish the taxpayer base, and we didn’t contribute enough in taxes to cover our future health needs as increasingly frail citizens.
Result: our children and theirs are going to be saddled with an expensive burden they can ill afford as droves of silver-haired boomers leave the workforce and consume a disproportionate share of public health resources in their senior years.
The situation is dire if you believe author Jeffrey Simpson. In Chronic Condition: Why Canada’s Health Care System Needs to be Dragged Into the 21st Century, Mr. Simpson notes that slower economic growth in the decade ahead will coincide with an aging Canadian population. He notes that wringing efficiency gains out of medicare will almost certainly not be enough to sustain it. He backs this up with evidence in 2010 from the OECD that “Canada could (only) lower by 2.5% its spending on health care were the Canadian health-care system to become as efficient as the best in the OECD.” This suggests we must be prepared to increase taxes, introduce parallel private services and user fees, or cut public services.
Simpson’s conclusion misses an important element — actually five important elements. Safety, effectiveness, appropriateness, accessibility and acceptability. Each of these dimensions of health care has an impact on cost. Examining the sixth dimension — efficiency — alone, to the exclusion of the others will miss the opportunity to squeeze significant value out of our public health dollars.
Let’s look at access, for example. Patients who wait long periods for surgery consume health care resources to manage their symptoms, like pain, while waiting; the longer they wait, the higher the symptom management costs. A report prepared for the Canadian Medical Association in 2008 put the total cost of excessive waits for total joint replacement at $26,400 per patient.
How about safety issues? Better risk management of patients can reduce the chances of infections, blood clots and heart attacks that put patients back in hospital after surgery.
Appropriateness of care decisions are also cost drivers. Here, identifying ‘the right patients’ could reduce the numbers who are routed to expensive testing and to a surgeon but do not require surgery. This is more common than most people realize, generating higher costs needlessly while increasing the waiting time for people who actually need the tests and surgery.
There are numerous examples of potential cost savings in each of the six dimensions of health care. The salient question is: are we doing anything about them?
In Alberta, a new concept has been launched that brings into play potential improvement in all of these dimensions. The concept, Strategic Clinical Networks (SCN), was launched in the summer with the first six of 12 high-volume, high-need areas of medicine: Bone and Joint Health; Obesity, Diabetes and Nutrition; Seniors’ Health; Cardiovascular Health and Stroke; Cancer Care; and Addiction and Mental Health.
These SCNs bring together all of the health care constituents — health professionals, patients, researchers, academics, business people and policy makers — in teams that have the opportunity to profoundly change the way services are designed and delivered, and to expand and exploit research and development of technologies.
Clinicians take on leadership roles in multi-stakeholder teams. Patients — the actual users — have a direct say in designing and delivering services. Business people bring a business perspective and entrepreneurial spirit to the table — and, as in industry, new ideas have to be supported by a rigorous business case. Results will be monitored and measured, a standard practice in business, which long ago recognized that improvement is impossible without measurement.
No other health jurisdiction in Canada has attempted such a highly inclusive approach to service design and research and development on such a large scale. Alberta’s advantage is its single provincial health care delivery agency, Alberta Health Services, which makes it possible to plan, launch and carry out innovative sweeping change of this kind.
The idea is spreading. The United Kingdom’s National Health Service, which is beset by a catalogue of burning issues that are exceedingly more complex and difficult than Canada’s, announced recently it is launching its own version of SCNs. The basic concept is the same: improve the quality of care for patients and bring greater efficiency to health care services.
Much of this is the work of baby boomers who are approaching their retirement years with more than a few ounces of creative juice still flowing.
As for feeling guilty, well, boomers don’t exactly have a history of feeling guilty about anything. But they do have a history of leading change. They have rocked, shocked and shaped the world like no generation before them. Don’t rule out Canada’s baby boomers righting public health care as one of their final acts of defiance against conventional thinking.
Cy Frank is an expert advisor with EvidenceNetwork.ca and the Executive Director of Alberta Bone and Joint Health Institute. He is also an orthopaedic surgeon practicing in Calgary, professor of surgery in the Division of Orthopaedics, University of Calgary, and the McCaig Professor of Joint Injury and Arthritis Research.
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