Canadians like to compare our health-care system to that of the U.S., but they should look further afield: They will discover other countries provide universal coverage that is more comprehensive, has better wait times and costs less, say two University of Toronto experts in a Toronto Star op-ed.
“We’re laggards when it comes to innovation, and the architecture of our system needs to evolve rapidly,” write Dr. Andrew Boozary, a resident family physician at U of T, and Dr. David Naylor, U of T’s president emeritus and a professor of medicine. Naylor led Canada’s Fundamental Science Review, which calls for a $1.3-billion increase in federal research funding over four years, as well as sweeping changes to how it is administered.
In the op-ed, Boozary and Naylor argue that how Canada finances and delivers health care hasn’t changed much in 50 years, focusing on hospitals and doctors. Funding of the system needs to be more integrated, they say.
“For example, insuring physiotherapy services provided in clinics or at home might save costs by reducing return visits to doctors or days in hospital,” they write. “There’s just no way to make that math work, or take other innovative steps, when each part of the system has a separate budget.”
Boozary and Naylor urge Canada to adopt an approach advocated by the Center for Medicare and Medicaid Innovation (CMMI), a U.S. hub that focuses on integrating payments around the patient.
“CMMI is the source of ideas like bundling all payments to hospitals and professionals alike when financing complex services that bridge hospitals and homes, like hip replacements,” they write.
An important part of CMMI is how it evaluates innovation, they write. “If something works, CMMI makes that payment option widely available. If it doesn’t, the model is tweaked and re-evaluated.”
Their conclusion: The hard reality – reinforced by multiple performance indicators and countless stories from frustrated patients and professionals – is that we just can’t keep delivering health care as we always have."