Canada’s health care system needs to be transformed to better meet current and future needs, and while various health care innovations have been implemented across the country, they are typically done in small scale and without improving the broader health system.
Many across the country recognize we need to move away from piece meal innovations towards real systemic change. The Conference Board of Canada held its 2nd annual Summit on Sustainable Health and Health Care to bring the pieces together in a larger discussion on how such innovations can be scaled and transform our health care system to be more sustainable. A broad range of health care professionals, researchers, government representatives, private sector leaders, and health and patient organizations attended the summit, including CARP. Most participants recognized that the needs of Canadians have changed since the health system was first created. The system was designed to provide acute care, but as the prevalence of chronic, long term conditions increases, the system will have to shift its focus of care. As a result, innovative ideas and examples of how health care can be transformed were shared, and several themes emerged:
Good health care requires more than just a good health care system
While a good health care system is important, research has found that other social determinants of health, such as income inequality, education, stress, and social support and exclusion, have a significant role in people’s health. As a result, presenters explained how everyone, including governments, employers, and citizens, can play a role. For example, many pharmaceutical and insurance companies are creating monitoring tools and programs to increase drug compliance, which not only improves patient health outcomes but also reduces wasteful spending. Also, some employers are embracing workplace health and wellness programs that improve the health of employees but also decrease absenteeism and increase productivity.
Investing resources needs to be strategic – not a question of how much we are investing but what are we investing in?
Most of long-term care services are used in institutional settings in Canada rather than at home. In contrast, in Norway, approximately two thirds of long-term services are used at home, according to the OECD. Home and community care is known to be much more cost-effective than institutional care but according to the Conference Board of Canada, Canada spends only 4.6-5.5% of total health spending on home and community care. As the demand for home and community care continues to grow, Canada needs to better invest its resources for better, more affordable and responsive care.
Fear of failure is hurting us – instead, scale up innovations
Many innovative programs that are reducing wait times, improving patient care, and reducing waste are taking place all over the country but many remain as pilot projects or are contained within the hospital or institution. For example, the Women’s College Hospital in Toronto created an Acute Ambulatory Care Unit that “provides urgent assessment, investigation, and management of patients with complex medical conditions”. It acts as an alternative to the emergency room (ER) to reduce wait times and meet the needs of patients needing medical attention but not necessarily from the ER. Speakers at the summit argued that there are good ideas like this but often the fear of failure prevents potential solutions from being implemented and integrated at a larger scale.
CARP’s One Patient model of care calls for just such approaches to health transformation. CARP’s One Patient calls for an integrated continuum of care that takes into consideration the full spectrum of health needs from first diagnosis or acute episode, through acute care, home and community based long-term care, through to end of life needs. It proposes a system organized around the patient so that it is easy to navigate, better coordinated, and also cost-effective. The Summit made it clear that the potential for large scale improvements exists, but real transformation will require leadership and commitment to action.