Russ Ford's Blog

The One Idea to Improve Health Care



This week I had the pleasure to be on a panel sponsored by the Etobicoke Rotary Club. We were asked the simple question, “What is the one thing you would do to improve health care.”

There are many possible answers but a reasonable starting point would be to first define the problem that needs fixing.  Some will say we are spending too much on health care while those of us working in the community health sector are struggling just to keep the doors open after years of government funding neglect.  There is also the dysfunctional and never ending power struggle between the government and the doctors’ union, the OMA, over which body actually runs health care in this province.

The government will say rising health care costs are the problem.  We need to get costs under control or the system will not be unstainable.  They will say that as a percentage of the provincial budget health consumes too much.

Such claims are a good example of how one can manipulate statistics.  Health care funding as a percentage of our government’s budget has increased because the government has maintained health funding while cutting the overall budget.  If the budget goes down and health care funding stays the same, you will get an increase in the percentage of the budget that is devoted to health.  We are not spending more as a percentage of our GDP today on health care than we have in previous years.

Granted, in absolute dollars we do spend a lot on health and for the most part Canadians are OK with that.  We seem to like our health care system.  Depending on the year we are either the second, third or fourth highest spender on health care.  The spending prize goes to the United States.  Even though their system is not universal, no country is even close to what they spend.  Pharmaceuticals and specialist care are a big part of their costs and their system does allow for profit.

If money is related to health outcomes then the United States should have the healthiest population in the world and we should not be far behind. At the moment the United States ranks 36 in the world on population health status and Canada ranks 30th.

Perhaps more spending does not lead to better health care.  Perhaps what you spend it on is more important than how much you spend.

Canada and the United States are the only countries in the G20 that spend more on health than they do on social services. As a percentage of GDP Canada only spends more on social services than Mexico, Portugal and of course the United States.

To put it simply,  European countries  get better health outcomes by spending less on health care and more on social services. They seem to get the relationship between a person’s health and their need for affordable housing, day care and recreation services.  They also seem to better understand that poor health is not just a physical matter; it is deeply influenced by psycho/social issues like poverty.

When we talk health promotion in Canada it is  about  changing individual behaviors centering on the “holy trinity “ of health promotion- eat better, don’t smoke and go to the gym.

While those are all good things to do, as a health policy it is sorely lacking.  Not everyone can afford to eat well or go to the gym and smoking is an addiction problem so let’s stop this individualized approach to health promotion.

New research is now supporting the notion that psycho/ social issues like depression and feelings of isolation are now as significant as the holy trinity when it comes to preventing heart disease.

The simple answer as to why we have such a poor record on population health is we do not spend the money correctly, we do not spend it on health promotion and continually throw money at clinical interventions assuming that by doing the same, and we will get different results.

This is not secret information.  There must be someone at the Ministry of Health who knows this.  That is why it is so puzzling and frustrating when you see our government espouse a new vision for health which is really the same old tired vision that got us to where we are today.

No better example than the latest “vision” Patients First.  Once again we are looking for a clinical rather than a community solution to improving health status.  The government seems to believe that the problem with our clinical system is they do not have enough control.  Patients First gives them all the power anyone could want.  But there is absolutely no research to support their primary contention that centralized control will lead to better outcomes.  In fact the research comes to an opposite conclusion.  Centralized control further marginalizes high risk people. Centralized control eliminates any possibility you can achieve system rooted in equity.

The government currently has a program called Health Links.  One of the activities of Health Links is to identify those that use hospital services the most and link them with a care coordinator who could provide access to more appropriate and less expensive care.

There is nothing wrong with that, except that it continues to address the problem within the clinical context.  I do not have any data on who these people are, but I can guess.  My guess would be that they are people who have mental health issues, are living in poverty with little or no social supports.  We can and no doubt will continue to put out money to address their individual concerns. I suspect however, we would have far greater success if we took that money and used it to build affordable housing, recreation and mental health services. If we really want to promote health equity as the government says it does, then invest in organizations that are actually addressing equity issues.

To do that would require a significant rethink at the Ministry of Health.  That rethink is my one thing that could improve the health status of the people of Ontario the most.

There is no joy in chanting, “We are number 30”.

Comments

Very true. Health doesn't

Very true. Health doesn't mean only physical health, all aspects need to be taken into account to maintain good health. Body and mind are interrelated, so any thing wrong with the mind could lead to many complications and affect emotional and spiritual health as well..Sometimes these are the root causes of many ailments if not addressed timely. The issues highlighted are major role players in the deterioration of health, so those need attention as well.

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