Editorial: Prevention key to health costs

Difficult times lie ahead for our health-care system. Every province but one is either planning to reduce health funding or has already done so. (Nova Scotia is the exception.)

According to a new report by the Canadian Institute for Health Information, there have been funding scale-backs across the country in the past two years. Adjusting for inflation and population growth, health spending declined in both 2013 and 2014.

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Moreover, further hardship lies ahead. Continued economic weakness, plus the need to pay down deficits, still dominates the national landscape.

The news is not all bad. The B.C. government began its restraint program earlier than most, meaning the period of outright cutbacks might be over.

But even so, the province is planning three more years of tight budgets. That means managers and caregivers have their backs to the wall.

The question is how we get through this. The last time a scale-back of this duration occurred — the mid-1990s — there were massive upheavals.

In B.C., about 700 independent health-care organizations were dissolved, almost overnight. More than half the Health Ministry’s staff became employees of regional authorities.

Thirty per cent of hospital beds were closed, and new surgical and wound-care procedures were introduced that enabled patients to go home sooner. Overhead and administrative costs were slashed.

Other provinces adopted similar measures, with success. Canada now has the lowest number of hospital beds per capita among 25 OECD countries.

We run our facilities more efficiently than most developed nations, and we also have fewer physicians and hospital nurses, per capita.

But that’s just the problem. We’ve been there and done that. What do we do for an encore? How much leaner can we get?

There is unquestionably still room for improvement.

Nationwide, Canada allocates $4,522 per capita to health care. The OECD average is $3,322 and New Zealand, with its highly advanced system, spends just $3,182. Clearly, there are savings to be had.

Physician salaries are one potential area for attention. GPs in Canada have the second highest incomes among the leading OECD countries, and specialists rank third.

Along with the U.S., we suffer from “Dr. Kildare syndrome” — the idea that physicians are more glamorous than other care providers.

In Europe, doctors play more of a team role. There is no evidence our high-income model gets better results.

But that is, in fact, the heart of the problem. Our health system is skewed toward complex interventions by highly paid experts.

We allow people to get sick or frail, then, when it is nearly too late, we step in with hugely expensive measures. In that world, the physician — as chief problem-solver — rules.

The European system leans the other way. Far more time and effort is spent on preventive efforts. That means better child care, extensive support for the elderly in their homes, and early intervention before ailments become threatening.

In this world, teamwork rules. The physician or specialist is just one part of a continuum that includes social workers, home-care nurses, therapists and counsellors. There is no pyramid, with one profession at the top and the others scrambling to compete.

Could this work in Canada? It would demand a far-reaching change in mindsets at every level. In particular, it would require a remodelling of the whole system of family medicine.

Yet in some form or other, this is the only viable option left to bend the cost curve. We’ve hammered hospitals. We’ve hammered waste and duplication. We’ve hammered middle management, and then some.

We can no longer afford a mentality that prefers last-minute crisis care to more timely — and cost-effective — interventions.

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