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$ilo $ystem of health care

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CALGARY -- Want to know what's wrong with health care? It's one of Canada's biggest businesses but it manages with the acumen of a roadside fruit stand.

That's my interpretation of the feelings of Cy Frank, who helped establish in 2004 the Calgary-based Alberta Bone and Joint Health Institute that set up new methods for replacing hips and knees. He's gone on to become a student of what's wrong with health care.

The results of the institute's work: Patients got significantly faster access to surgery, better recovery of health, less pain and greater return to normal activities. Surgeons were more satisfied. And there were cost savings for the public health system.

Frank wants to spread the institute's ideas to other areas of health care. "An examination of value for money is long past due," he says. "It would unveil pervasive and deep-rooted waste and duplication in public health care systems across Canada."

Frank says these are some examples: multiple referrals of a single patient in an attempt to shorten long waits; inappropriate use of expensive diagnostic tools, such as MRI; repeat gathering of the same patient information because there is no common database; expensive new drugs not subject to testing to see if they are better than those available.

Frank shared his ideas on health care with me at a luncheon at Calgary's distinguished railway hotel, the Fairmont Palliser.

A value-for-money audit would also show, he says, that the increased costs of our aging population -- a favourite whipping boy of health care critics -- pales in comparison to the cost of waste and duplication.

As well, he says, "Canadians have been presented with a list of stale, simplistic and unpalatable options: increase taxes, cut services, degrade service quality, introduce a parallel privately funded system or some combination of these."

A lot of people work hard in health care and do good jobs. The problem is many of these people work in separate silos. Few computer-assisted information systems properly connect all the silos. So, we have problems examining costs across the whole health-care system.

The lack of an integrated system means the decisions of doctors and patients can't be tracked and that means the notion of accountability is undermined.

More than 70 per cent of the costs in Alberta's public health care system are driven by physicians, says Frank. Patients, dazzled by Internet diseases and cures, also push up costs.

Inadequate information systems also increase waiting times and expenses when moving patients from one silo to another.

A report last week by the Canadian Medical Association supported many of Frank's concerns. The CMA did an online survey and a series of town hall meetings. The report found "the health care system is fractured to such a degree that it is, in some ways, a system in name only. From the perspective of the patient as a consumer of health care, it does a poor job of transitioning patients from one level of care to another."

Furthermore, "it does not provide patient-centred care -- the care people need when they need it."

In addition, Chris Simpson, chair of the Wait Time Alliance and head of the cardiology division at Queen's University in Kingston, said, "If you need one sort of medical service, we can deliver that, and we can do a pretty good job of it."

But, he adds, patients who need to see a series of practitioners must often wait between each step of their care. "It's the totality of that experience, I think, that people are frustrated with," he told the Globe and Mail.

All of this seems simple enough. Why is nothing done? Because politicians, by and large, are nervous about touching health care. An integrated health system would make some doctors and patients angry; they like being unaccountable for their actions.

Frank's ultimate proposal drives them crazy. He would like a province, such as Manitoba, to have one health authority. That way you can introduce evidence-based care, make infrastructure more efficient, set out cost-effective procedures for doctors, encourage collaboration among health-care professionals, start a program to measure results, improve accountability, ensure transparency and work on incentives for improvement.

To ensure a province-wide system is sensitive to its clients, it should, says Frank, have feedback centres where people can come to voice their concerns.

If no reforms are made, says Frank, health care will cost a family of four $42,800 a year after inflation in just 20 years.

Here's an idea: The current health care agreement, which increases federal spending six per cent a year, ends in 2013-14. In the last federal election, all the federal parties, terrified by the very mention of health care, agreed to extend federal help at six per cent a year beyond 2014.

But why not make this federal funding contingent on a province treating health care like the big business it is?

A group of major companies, notes Frank, will announce the "Canadian Alliance for Sustainable Health Care" to argue "costs are unsustainable, and equally importantly, that political leaders have failed to find long-term solutions."

He adds: "It's a warning shot that industry will promise a cure for Canada's chronic health-care spending disease if government is not up to the challenge."

Tom Ford is editor of The Issues Network.

Republished from the Winnipeg Free Press print edition August 22, 2011 A12

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