From: Don Drummond and Dr. Duncan Sinclair
To: All Canadians
Date: June 9, 2016
Re: It's Time to Create a Real Healthcare System
Recently Ontario’s MOHs issued a cris de coeur pleading for legislation to regulate the prescribing of opiates and for the wide distribution of naloxone. Asking elected politicians to write what amounts to clinical guidelines adds yet more evidence that Canada’s cherished but fragmented, costly, inequitable, and not-very-effective healthcare non-system is in desperate need of fundamental change.
Some provinces have ‘bent the cost curve’, slowing the rate of healthcare’s cost growth. But ‘pruning’ by budgetary constraint won’t correct the glaring inequity that poor Canadians still live shorter lives in poorer health than wealthier ones or that our ‘system’ produces mediocre to poor results relative to other OECD countries or that a self-governed and regulated health profession must appeal to government to solve a problem with over-prescribed pain-killers. ‘Root and branch’ reform is essential.
What’s to be done?
Step one is to find out what is going on in the ‘system’ and what its outcomes are. We need a comprehensive health information management system to link hospital funding with the services they provide and to hold doctors and others accountable for the results of their work, including their adherence to sound clinical guidelines.
Step two is for publicly funded health insurance programs to meet the basic principle of Canadian Medicare; nobody should be denied access, based on ability to pay, to all the healthcare services needed to preserve or regain good health.
The reality is that governments are too distant and occupied with other priorities to provide the ‘system’ with effective governance. While keeping their fiduciary responsibility for its financing with public money, step three is to establish an arms-length, a-political body, much like a corporation’s Board of Directors, to govern the ‘system’.
And step four is “to revamp the delivery system” something Tommy Douglas said in 1984 was “the really big step we haven’t done yet”. It’s time to put primary care firmly at its center, provided by teams of health professionals and encompassing home and community care. It’s time to ensure every Canadian has a primary care home and that those teams, together with hospitals and other institutions, discharge their primary responsibility to provide the range of services that meet the people’s needs for ready access and excellent outcomes. It’s time to change the incentives so that all health professionals, individually and collectively, are held accountable for those outcomes, measured in terms of the health of those they serve, and for the overall productivity of their team, hospital, or other organization. It’s overtime to organize the silos we now refer to as our healthcare system into a real one.
Don Drummond is Stauffer-Dunning Fellow in Global Public Policy and Adjunct Professor, School of Policy Studies, Queen’s University
Dr. Duncan Sinclair is Emeritus Professor of Physiology and Fellow, School of Policy Studies, Queen’s University
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