By Peter Lindfield, published in the Telegraph-Journal 21st August 2012
There is widespread agreement that Canada’s health-care system cannot continue. With costs of approximately $200 billion annually in public and private money, this system is ill-suited to an aging population, with public costs outstripping government revenues and prevailing rates of inflation.
Many point to demographics for the steady increases in health-care cost, but blaming an aging population for health-care costs spiralling out of control reflects an inaccurate perception of the challenge. A more correct reading reveals that we are missing opportunities to manage and contain costs. A profound challenge facing health care has less to do with demographics and more with the intersection of health-care technology and public expectations about access to these technologies.
In Too Much Health Care, a 2009 article in the Literary Review of Canada, Dr. Charles Wright, former Scientific Officer of the Canadian Health Services Research Foundation, pointed to four areas that challenge future health care: “new surgical techniques, such as knee and hip replacements, that have grown far beyond the rate that would arise from population growth or aging alone; new diagnostic techniques, such as MRIs and PET scans; pharmaceutical drugs; and end-of-life care that has become highly reliant on expensive technologies.”
According to the Canadian Institute for Health Information, Canada spent almost $30 billion on prescription drugs in 2009. Canadians pay 30 per cent more for medication than the average in OECD countries. Drugs now represent the second-largest expenditure in health care, second only to those for hospitals.
Dr. Wright provides an example of the questionable benefits wrought by new pharmaceutical products. He cites the drug Avastin, marketed for patients with colorectal cancer and now on most provincial drug lists. Research provides evidence that Avastin can indeed prolong life. Dr. Wright states that the questions about the drug’s appropriateness revolve around “how much more life, at what cost and causing how much harm? The answers are an average of four months, $50,000 per patient and a stunningly wide range of adverse effects from high blood pressure to gastrointestinal problems to severe hemorrhage. Half of the patients receiving the drug get no benefit whatsoever.”
These are difficult questions certain to initiate heated debate. But the public may not be able to continue to fund services that offer limited benefit but place great financial strain on the health-care system. The public can do more to place limits on inappropriate medical care. To do this successfully, the public needs to be more informed about the balance of potential benefit and risk that is inherent in any medical intervention.
These limits still operate within the principle of equitable access to medically necessary care regardless of financial means. That is the most desirable characteristic of Canadian health care. The future of this equitable access requires that we recognize the paradox that health-care interventions can cause more harm and more cost than warranted by the benefit. Dr. Wright asks, “How many would decline treatment if they were made fully aware of the extent of the benefit and the probability of complications?”
There is growing recognition that without major changes in our thinking, our health-care system is unsustainable. There are two critical issues that need to be faced squarely. The first issue deals with the limits of financing this system and has been the subject of continuous discussion especially in recent years. The second issue focuses on the appropriateness of products and services delivered within the system. Attention to this issue has been conspicuously absent.
Modern technology has led us to the point where even unequivocal supporters of universal health care now recognize that there is a limit and that we have reached it.