By David Godkin
A devastatingly frank report by an advisory panel on health care innovation in Canada has described the country's overall performance as "middling" by international standards this despite health care spending as "high relative to many OECD countries. The report, titled "Unleashing Innovation: Excellent Healthcare for Canada," also noted that Canada "lags" in comparison to many other nations in the meaningful use of digital resources, patient records access, virtual care applications and data standardization.
"In particular, for both drugs and devices, Canada's regulatory environments and markets are characterized by fragmentation, duplication and inconsistencies," the report said.
Even more damning, the report said efforts to modernize health care infrastructure and broaden the scope of public health care coverage between the late 1990s and 2004 resulted in the loss of billions of dollars in health care spending. Since then, outside minor reductions in wait times for patients seeking medical services, efforts "to improve health care and augment its value are limited in part by a serious shortfall in working capital."
In 2004, the federal government unilaterally determined that 6% annual health care funding increases to the provinces would end in 2017. Instead, funding transfers would be tied the annual rate of GDP growth or 3% per annum. This created a firestorm of controversy, in part because fiscal demands upon health care vary dramatically from one province to another and because the provinces weren't consulted about the change. Monica Dutt, chairman of Canadian Doctors for Medicare told Medical Device Daily Ottawa's failure to consult continues.
"This report could have been an opportunity to bring the federal government back into the conversation. But it was released without any fanfare probably because it calls on the federal government to invest in health care and that's not something they've been willing to do."
Long on ambition, but short on detail, a recommendation to conflate the mandates of three existing agencies under a new Healthcare Innovation Agency of Canada (HIAC) to quickly "scale-up" innovative health care solutions begs important questions, said Dutt. Why consolidate the Canadian Foundation for Healthcare Improvement, the Canadian Patient Safety Institute and Canada Health Infoway when "we haven't seen them working on health care clearly over many years? Is this just moving pieces around as opposed to creating something new and innovative? That's not clear from the report."
Canada has to try something different
Someone who defends the report is Chris Simpson, president of the Canadian Medical Association representing Canadian physicians. He told Medical Device Daily he agreed a great deal of money has been lost upgrading Canada's medical infrastructure, much of that "trickling down to a lot of low hanging fruit" so that policy makers "tread water rather than make really meaningful improvements to the system." Nor was Simpson surprised that Canada's ranking in health care outcomes should have fallen to "at or near the bottom of prestigious rankings."
"Getting those rankings closer to the top has got to be a big part of what we aim to do. But we can't possibly hope to achieve these grand improvements in metrics without some coordinated, integrated approach."
Despite the setbacks Simpson said he remains bullish on the future of Canadian health care innovation. He believes the new independent HIAC "with meticulously excellent governance, clear goals and accountabilities is exactly what we need to really kickstart some of the change that needs to happen."
To Dutt's concerns that conflating three agencies into one to get major structural reform may amount to moving chairs around on the deck of the Titanic, Simpson suggested that the country has no choice but to try something different. "We have a $220 billion health care system and nobody's in charge. This [report] appears to suggest that this agency would really be in charge in bringing all these disparate groups together. It is grand, but I think it is the right approach."
Coordination with the provinces seen lacking
Who on the government side is in charge? The Canadian government provides funding to the provinces which then run Medicare, but Ottawa also has a constitutional mandate to shape health care policy and set standards. Since becoming the prime minister 10 years ago, Stephen Harper (a member of the Conservative party) has met only once with the provincial premiers. Simpson admitted this has been a "sticking point."
"But the answer lies in embracing the complexity of those relationships rather than being stymied by them. We have to recognize that there are local, provincial and regional innovations . . . but we do need the federal government to come back to the table to help galvanize a consensus around structural reforms."
"Absolutely," agreed Mark Thompson, the head of the doctors association in Saskatchewan. Thompson told Medical Device Daily he takes pride in the success doctors and policy makers in his province, the home of Canadian Medicare, have had working together.
"If you look at our aging population and the fact that seniors care is going to consume a lot of our resources, these discussions need to be happening. I think the federal government owes it to all Canadians to be having those discussions at the top level with the provinces."
The litmus test will likely come after the federal election this fall. Given his past performance, it's unlikely that Harper will budge from his austerity plans for Canadian health care if he is returned to power.
The two opposition parties have sternly reproached Harper for turning his back on the province's call for greater consensus around health care and have vowed to behave more cordially if handed the reins of power.