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Thursday, June 2, 2011

Fault Lines in the Health Care Bedrock

Guest blogger Pamela C. Fralick joined the Canadian Healthcare Association as President and CEO in February 2008. She also acts as co-chair of the Health Action Lobby, a coalition of 37 national health associations and organizations, co-Chair of Canadian Coalition for Public Health in the 21st Century, and Chair of the Quality Worklife-Quality Healthcare Collaborative. 
I’d like to begin at the end. This report concludes “...the next push lies in having all governments work together in the interests of all Canadians, which was the real promise of the Accords.”  And therein lies the rub... 

I was struck by my growing frustration as I read page after page of ‘optimism, but...’.  In other words, yes, there are advances being made, but the patchwork quilt of progress results in two major problems: 1) improved health outcomes as a result of the changes are still difficult to assess; and 2) the unevenly-applied changes across the country challenge a key value and condition on which our health system is based - universality.

Now back to the beginning for a few observations.

First, what bravery is (regrettably) required to embrace the transparency increasingly called for by that ‘rabble-rousing’ public!  But, in fact, the 2003 and 2004 commitment by the governments of Canada to report on their progress concerning significant health system reforms is likely unprecedented, and is to be commended.

Secondly, this Council report has done an excellent job of synthesizing an overwhelming amount of material, culled from multiple sources, into a plain-language, well-organized, user-friendly synopsis. It is anchored in evidence, and the reader who wishes more detail has the references to pursue.

Thirdly, and even more impressively, the report concludes we are actually making progress on many fronts, if not all, indicating that “in the seven years since the accords, almost every jurisdiction has made significant changes to the way they deliver health care”.

The review does, however, reveal two significant fault lines in what our 14 health systems are producing for Canadians:  1) we are not adequately measuring the impact of these system changes on health outcomes, and 2) a basic principle of the Canada Health Act, universality, is not being practiced consistently across the country.

The stated intent of the report was to assess improved access to care, the quality of that care, and health innovation. It has dealt thoroughly with available data and change regarding access, and equally so with innovation. However, and through no fault of its own, this report is simply not able to address the ‘quality’ question, with a few exceptions.

Despite calls for accountability, monitoring and evaluation, whether in the actual accords or in any of the many reports which have emerged following their signing, we are not there yet. For instance, comparability among provinces is still in its earliest stages, seven years on. Public information on wait times guarantees is not readily available, and data on its utilization is simply not known. Information from imaging centres is not readily available. The list continues.

So, while we can and should take modest pride in the strides accomplished, this Council report reveals we can’t simply ‘buy’ health. We can pick away at the edges of the system, and we can introduce isolated changes that collectively, may ‘do good’. We’ve identified and/or put many excellent ‘tools’ in place, from e-initiatives and emerging drug information systems to integrated services and improved role definition.  But we must also pose some very hard questions of each other, and our leaders:

·         What about the legislated entitlement of every Canadian to “the same level of health care”, wherever they live in Canada?

·         What about the right of the taxpayer to know that the changes his/her dollars are buying, are producing the health outcomes he/she expects for the investment?

·         When will all funders and influencers embrace a meaningful, collaborative approach to our efforts, ensuring the health of Canadians and the nation supersedes any jurisdictional or sectoral interests?

I look forward to a future Health Council of Canada report, when they will be able to connect the dots between health system changes and actual health outcomes, when comparable health services are available to all Canadians, regardless of where they live, and when targets and measures and accountabilities are commonplace.

Key Words: Health Indicators, Accountability

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