Published in the Telegraph-Journal 12th October 2012
When Canadians hold up their health care system as the world’s finest, our implicit assumption is that no country could do better. Or at least the U.S. cannot do better, unless the American patient pays a significant premium for the privilege. Canadians think generally that their model needs only fine tuning to achieve the highest productivity in health care. But the Canadian health care model is not a paragon of efficiency. Canadians are making increasingly larger expenditures on health care but are receiving relatively less in return.
And there are limits to available funding. We are becoming more aware of the impending crisis in health care financing, especially in the wake of the federal government’s unilateral funding formula that provides hard financial limits to the provinces. We need to find ways to improve the potential for innovation to enhance the overall delivery of health care over the next decade. We need to make critical financial decisions based on key demographics, the role of prevention and treatment in health care systems, and on important industry trends in emerging markets for the health care sector. Expensive pharmaceuticals are emerging in markets that are already straining health care budgets. We will need to make decisions over what can be covered under our current model.
That our health care system is in crisis may seem a surprising conclusion given the efforts of dedicated health care professionals and the promise of genomics, regenerative medicine and information-based medicine. The baby-boom generation is going to have high expectations not only of health care quality but of its longevity. Expensive new technologies and treatments will soon create an exponentially larger cost burden.
With our health care system shouldering more pressure, the benefits of disease prevention are becoming more obvious. To help ease this burden and to give New Brunswickers better access to health care, elements within the current system will need to change. A number of organizations have undertaken research to better understand how to help drive the transition to customized care including developing incentives for improved health outcomes, reforming health care’s regulatory structures to enable competition and innovation, undertaking better patient communication to support shared decision making and developing workforce models that allow greater flexibility, collaboration and customization through electronic medical records.
We need to make realistic, rational decisions regarding lifestyle expectations and acceptable behaviors. We need a focused discussion on how much health care is a societal right against what will be delivered as a market service. This discussion needs to extend beyond the limited and often staged arguments that currently characterize discussions of health care responsibilities. A radical rethinking of the health care accountability structure including appropriate authorities and responsibilities is long overdue.
These challenges, combined with the emergence of a new environment driven by the dictates of economic uncertainty and demographic shifts are already forcing fundamental changes in health care practices. Health care systems that fail to address this new environment run the risk of reaching a fiscal limiting point where immediate and major forced restructuring will be necessary. These realities will complicate our health care options. Innovative technologies will create the prospect that some treatments that currently are at the leading edge may become standard approaches but while there exists a temptation to rely on technological innovation to solve the problems of health care, they cannot be a panacea.
Governments will need to address the challenges of the current system by providing leadership and political will to remove obstacles, encourage innovation and guide society to sustainable solutions. Citizens will still expect their elected officials to be accountable for the most difficult decisions.