Innovation nation:bridging the gap

Amidst all the bleak talk about the future, at last some forward thinking for our healthcare system. "Work smarter, not harder"

By Susan Usher

"Healthcare is unsustainable." That was the predictable media reaction to the publication in March of the "Understanding Health Care Cost Drivers and Escalators" report on the sustainability of Canada's healthcare. When Alberta approached the Conference Board of Canada (CBOC) to do the survey, they wanted them to delve into the financial side of the issue, and the picture isn't pretty. But that may not be the whole story.

The CBOC, Canada's foremost independent applied research group, had an excellent vantage point having just completed a study for the provinces and territories looking at the fiscal prospects for each level of government. That study was similarly bleak, showing that while federal government surpluses would rise steadily until 2020, provinces and territories would reach an aggregate $11 billion deficit by 2019/2020, and rising healthcare costs would be largely to blame.

The report commissioned by Alberta took the research one step further and looked into where these spending increases are coming from and what they're accomplishing. And according to the report, what we're getting for our money is nothing to be proud of. Canada is the third highest spender on health care among OECD countries, but ranks only 13th on health status and system performance.

Vital stats on Canada's health system Ranking among OECD countries for health status: 5 Ranking among OECD countries for non-medical factors affecting health and demand on health services: 15 Ranking among OECD countries for health outcomes: 20 Ranking among OECD countries for public health care spending: 6 Number of general practitioners per capita: higher than average Number of specialists per capita: below average Number of MRI units per million population: below average Availability of radiation therapy equipment: above average Source: "Understanding Health Care Cost Drivers and Escalators," the Conference Board of Canada, March 2004

ANOTHER SIDE TO THE COIN
But the lead author and Director of Health Programs at the CBOC, Dr Glen Roberts, feels that the full story of the sustainability of Canadian healthcare cannot be told in cost-analysis alone. "We were asked to do something on cost but we recognize that it's not just about cost, but also about investing in innovation," he says.

The report points to demographics, higher expectations and increased prevalence of chronic diseases as structural factors that governments cannot do much about. Cost escalators, including pharmaceuticals, home care, health professionals and new technologies are termed 'mechanical forces' � governments do have a degree of control over how much effect they exert on healthcare costs. From the viewpoint of provincial health ministries, new technologies have to be introduced sparingly and carefully to control costs into the future. But there's a lot of opinion out there that indicates this kind of knee-jerk reaction might not be the best way forward.

In his introduction to the report, Dr Roberts ruminates on the need for Canada to invest in innovation and capture a substantial share of the worldwide health product and services market. While the report portrays a public system that risks bankrupting the provinces and provides only middle-of-the-pack outcomes, Dr Roberts extols the value and virtues of medicare. "The healthcare systems provide sustainable employment, add to the Canadian knowledge-based economy, provide for economic prosperity and make Canada an attractive location for the business sector," he writes.

"We wanted to stress that this report is not meant to pit one group against another," Dr Roberts told NRM, "but to do some solid research that will create discussion and recognize that innovation is a key component of productivity. The discussion of cost that forms the bulk of this report doesn't align very well with that innovation thinking."

A THIRD WAY
A central challenge, in Dr Roberts' mind, is ensuring that innovation brings higher productivity in the health sector. Part of that, he feels, involves making sure that innovation is used beneficially in health care. "MRIs for example, are appropriately used sometimes and inappropriately used in other instances. 'Is it innovative? Who is it innovative for?' We don't always have enough detail," he says. Dr Roberts, who was a practising physician for 15 years, wants to send the signal to people in the healthcare system that the CBOC study is not trying to beat them up. "I would like to see funding for things that help them work smarter, not harder."

As a research organization with members from both public and private sectors, the CBOC is well placed to tune in to the parallel monologues going on in cash-strapped provincial health ministries and innovation-centred ministries of industry. Determining the sustainability of Canada's public healthcare system requires addressing, and bringing, the two challenges together.

And there's always more to the story. An internal Finance Department study obtained by the Globe and Mail in April concluded that healthcare will remain affordable over the next 40 years. "As the country gets richer, it will be able to afford more for healthcare as well," writes study author Alison McDermott.