Saving Health Care without Going Broke

ABJHI Archive

From The Evidence Network:

Let’s move beyond private vs. public debate

(A version of this commentary appeared in The Huffington Post, Troy Media and The Mark.)

With the election behind us, Canadians can look back and appreciate that we spent upwards of $300 million on an examination of personality, while policy largely escaped unscathed by serious scrutiny.  Health care, which pollsters insisted was the issue of greatest concern to voters, was summarily dismissed by our political parties with a unanimous promise made up of two simple words: “more money”. 

Even a report by former Bank of Canada governor David Dodge failed to ignite the serious conversation Canadians need to have about a health care system that, as Mr. Dodge put it, is suffering from chronic spending disease.

This is one chronic disease that is life-threatening.  Canadians clearly cannot sustain increases in health care expenditures that, left unchecked, will in just 20 years bring spending after inflation to a whopping $42,800 a year for a family of four.

But throwing more money at the problem will only hasten the onset of death.  The time is long past due for informed people to steal the platform from entrenched parties who want Canadians to think they have only a choice between ever spiraling costs and private health care.

As noted health policy analyst Michael Rachlis said in a recent interview: “For me, it’s groundhog day every day.  I wake up and we’re having the same stupid debate.  We’re not including the fact that we can solve these problems.  And then we end up debating whether we should look more like the U.S. system.”

Eliminating waste and duplication

The evidence suggests that while unsustainable cost increases are occurring, they are not a direct result of demographics. In fact, embedded and pervasive waste and duplication are the major drivers of spiraling health care costs that now swallow $12 of every $100 of GDP.  And the irony of the situation is that throwing ever-larger amounts of taxpayer dollars at the problem without measuring value often simply results in more waste and duplication.

Where are the waste and duplication occurring?  All around us.  They occur every time a frustrated family doctor gives a patient referrals to multiple specialists hoping one will have a quick opening.  Every time a physician sends a patient for an MRI when less expensive options, such as an x-ray, would provide all the diagnostic information needed.  Every time a patient needing multidisciplinary care goes from one silo of care to another where the same information is collected all over again.  Every time a new drug comes on the market after testing against a placebo instead of being compared to existing drugs that are less expensive and already proven effective.

Using business solutions within a public health system

Evidence also suggests that we need not adopt private health care to fix these problems.  But adopting private industry principles within our health care system to fix them is not a threat. It is actually an opportunity.  A good place to start is with the basic business formula of continuously eliminating waste, improving quality, giving customers what they need, and incenting performance.

Let’s look at the big-box store formula as a place to start.  This approach offers one-stop shopping, volume-enabled low pricing and the ability to control quality and cut out waste by centralizing a large operation under one roof.  These attributes are as important to public health care as they are to industry.  Like retail customers who have all their shopping needs — clothing, electronics, hardware, etc. — under one roof with greater choice at a lower price, patients with chronic diseases that require multidisciplinary care could have family doctors, surgeons, specialists, nurses, therapists and dieticians in a single location.

Chronic diseases such as arthritis, diabetes and hypertension — pervasive in our society — are best treated in the kind of multidisciplinary environment that the big-box concept can support.  Instead of being shunted from one silo of care to another, patients find themselves at the centre with health professionals working as an integrated team.

This is occurring in Ontario where the Family Health Team model offers a wide scope of services by multidisciplinary teams providing integrated care.  Remuneration is weighted heavily to incentives to provide preventive services and chronic disease management.  In just six years, 170 teams have been established.

In Alberta, the big-box concept is in its early stages for osteoarthritis patients who need a hip or knee replacement.  Patients in some locations can be seen by an orthopaedic surgeon, an internist, an occupational therapist, a physiotherapist, a dietician and a nurse, with a case manager to coordinate their evidence-informed care — all under one roof.  The next logical step is to expand services to a broader range of musculoskeletal conditions in these clinics and to network even more people to work seamlessly in teams. This approach can also be extended to all other disease areas.

All across Canada, hundreds — perhaps thousands — of health care professionals are involved in innovative approaches like these that are demonstrating we can indeed get more value for our health care dollar while remaining in a public health system.  More access, more quality, more of what the customer — the patient — needs.

Cy Frank is Executive Director of the Alberta Bone and Joint Health Institute and an orthopaedic surgeon practicing in Calgary, Alberta. He is also an expert advisor with