Dr. Brian Day @DrBrianDay

Health system unsustainable without private sector help

Apr 01, 2008

By Terry Hadley

Dr. Brian Day, president of the Canadian Medical Association (CMA), faced the question of an unsustainable health system head on when he addressed The Vancouver Board of Trade.

“We have some who even deny that costs are rising even though there has been a 400 per cent rise in health costs between 1984 and 2006, with just a 25 per cent rise in population (2005 dollars). That is unsustainable inflation,” he told the luncheon event sponsored by the British Columbia Medical Association (BCMA) and LifeLabs.

Day said The Vancouver Board of Trade has consistently pointed the need for change in health delivery, moving towards “a patient-focused” system.

“Instead of having a system that works to serve patients, we have patients that are forced to work the system as they languish on waiting lists for care,” he said, citing CMA research released in January that patients waiting for care cost the economy $14.8 billion.

Other research ranks the Canadian health system well below par. After seven years of surveys, and with no political agenda according to Day, The European Consumer Powerhouse’s survey released last month ranked Canada 23rd against 29 European countries, including Slovenia, Romania and Lithuania. Canada came in last in terms of value for money.

“How do we fix the problem? The answer is simple. Empower the patient. Change the focus to patient care,” Day said, adding the system lacks patient-focused, performance incentives or service-based funding of hospitals.
“The Organisation for Economic Co-operation and Development (OECD) has stated unequivocally that patient-focused funding will increase productivity and reduce wait lists, even in primarily government operated systems.”

Day said he opened the Cambie Surgery Centre in 1996 in response to the pressures of massive wait lists. His OR time had been reduced from 22 to five hours a week (10 hours was required to maintain Canadian competency levels at the time) and he had 450 patients on the wait list.

“It is time to assign the private-public rhetoric on health care to its true and deserving place in Canadian health policy. It is a relic of tedious and tiresome propaganda and falsehood that is undeserving of debate.”

Day said it is a fact the private sector already props up the health system. Just the names of buildings such as the Jimmy Pattison Pavilion are visible evidence of the role of private philanthropists, along with private contributions made through 80,000 charities that are not even accounted into the equation when Canadian health costs are described. On top of that, 70 per cent of Canadians have private insurance covering “medically necessary services.”

“Canadians know that a vibrant economy and a successful business culture are absolutely necessary if we are to fund health care and other social services,” Day said.

Day said to build a more patient-focused system, the CMA’s current campaign, More Doctors, More Care, stresses more doctors and training facilities are badly needed.

Day reported Canada is 26,000 doctors short of the average in developed countries, dropping from fourth in the world in 1970 to a current ranking of 24th.

He proposed partnerships with the private sector to create new medical schools, with 300 Canadian medical grade-A students currently having to study in Ireland, and 220 in Australia.

Efficiencies in the system also have to be addressed. Day said in a recent survey of doctors’ use of electronic medical records, Canada was last among eight developed countries. Canada spends one-third of the OECD average on IT in hospitals and a substantial number of avoidable hospital deaths are due, in part, “to the absence of available information in a timely manner.”

As a result, the CMA has developed a new online personal health record allowing patients to communicate securely with their physician through a mydoctor.ca portal, allowing patients to use online tools to track and report chronic conditions such as asthma, blood pressure and weight.

“The chronic conditions like asthma, blood pressure and obesity are often difficult to manage and are also responsible for over 70 per cent of health costs,” said Day. “This initiative is about medicine evolving to meet the needs of 21st century patients.”

Day still believes Canada can have the best patient-focused health-care system in the world. “But we have to act now,” he said. “And governments need our help; the low international ranking of our health-care system should be a wake-up call.”