It's
a great shame that my old schoolmate Mike Rachlis (we went to school
together in Winnipeg) has to devote so much of his time and energy to
countering the heavily financed misinformation campaigns that are
trying to undermine Canada's world class, universal, single-tier health
care system, because he has some well-researched, innovative and proven
ideas on how to make the Canadian system even better.
For those
unfamiliar with the Canadian situation, (mostly) US-based corporations
are lobbying furiously to get our governments to abandon Canada's
public system and replace it with a US-style, two-tier, system, despite
the fact that the US system provides most Americans (excluding the
rich, overprivileged elite) with demonstrably poorer health care
(Mike's books have substantial data to back this assertion up), and are
much less efficient and effective (health care costs consume 15% of US
GDP compared to 9% in Canada, although millions of Americans are
uninsured or underinsured, and the bureaucracy of the US system is
stifling, with paperwork consuming as much as 40% of spending, far more
than in Canada, to the point the NYT recently moaned that many
Americans were so overwhelmed by the bureaucracy of the system that it
was interfering with the quality of the care they receive).
The
reason for this lobbying is obvious and self-serving: Big Pharma and
Big Medicine make substantially higher margins selling into the
American system, and they want to con Canadians into believing that
they should want such a system as well. So waiting times (although
comparable to those in the US) are trotted out as evidence that
Medicare is broken and the government is necessarily less capable of
running a healthcare system than greedy private corporations. The con
is working -- the Conservative party in Canada and in Alberta, always
willing to help generous foreign corporations line their own pockets in
return for fat campaign contributions -- is helping out with the
misinformation campaign. So Mike has to focus much of his attention to
countering the lies with hard facts, and his wise advice for improving
the effectiveness of the Canadian system through innovations (most,
ironically, borrowed from American community experiments) have received
pathetically little public attention. The media dumb down the debate to
"public vs. two-tier private" systems (Canadians consistently and
overwhelmingly prefer the former, despite the money spent to try to
convince them otherwise), and, except for the short-lived Romanow
report (which most governments praised, but clearly don't understand,
as they have implemented few of the recommendations other than
committing more money to the system), there has been almost no
discussion of how to make the system even better.
Mike's newest book, Prescription for Excellence: How Innovation is Saving Canada's Healthcare System
(the choice of "is saving" rather than "could save" was presumably
deliberate), is his latest attempt to bring attention to some of the
practices that have been applied in various communities around the
world, and which, if adopted by Canadian communities, could put an end
to any doubts that Canada's system is a world class model for other
countries.
Notice the focus is on communities. What Mike is calling for is sharing of information and best practices, and coordination
of community-based healthcare initiatives, not massive centralized
systems. He understands that networks work much better than
hierarchies, but laments the lack of effective community-based networks
in healthcare worldwide.
The book lays out the principles and
rules for effective healthcare established by the US National Institute
of Medicine's groundbreaking 2001 Crossing the Quality Chasm report:
Principles: Health care should be:
- Safe—avoiding injuries to patients from the care that is intended to help them.
- Effective—providing
services based on scientific knowledge to all who could benefit and
refraining from providing services to those not likely to benefit
(avoiding underuse and overuse).
- Patient-centered—providing
care that is respectful of and responsive to individual patient
preferences, needs, and values and ensuring that patient values guide
all clinical decisions.
- Timely—reducing waits and sometimes harmful delays for both those who receive and those who give care.
- Efficient—avoiding waste, in particular waste of equipment, supplies, ideas, and energy.
- Equitable—providing
care that does not vary in quality because of personal characteristics
such as gender, ethnicity, geographic location, and socioeconomic
status.
Rules: Health care processes should be redesigned in accordance with the following ten rules:
- Care based on continuous healing relationships.
Patients should receive care whenever they need it and in many forms,
not just face-to-face visits. This rule implies that the health care
system should be responsive at all times (24 hours a day, every day)
and that access to care should be provided over the Internet, by
telephone, and by other means in addition to face-to-face visits.
- Customization based on patient needs and values.
The system of care should be designed to meet the most common types of
needs, but have the capability to respond to individual patient choices
and preferences.
- The patient as the source of control.
Patients should be given the necessary information and the opportunity
to exercise the degree of control they choose over health care
decisions that affect them. The health system should be able to
accommodate differences in patient preferences and encourage shared
decision making.
- Shared knowledge and the free flow of information.
Patients should have unfettered access to their own medical information
and to clinical knowledge. Clinicians and patients should communicate
effectively and share information.
- Evidence-based decision making.
Patients should receive care based on the best available scientific
knowledge. Care should not vary illogically from clinician to clinician
or from place to place.
- Safety as a system property.
Patients should be safe from injury caused by the care system. Reducing
risk and ensuring safety require greater attention to systems that help
prevent and mitigate errors.
- The need for transparency.
The health care system should make information available to patients
and their families that allows them to make informed decisions when
selecting a health plan, hospital, or clinical practice, or choosing
among alternative treatments. This should include information
describing the system’s performance on safety, evidence-based practice,
and patient satisfaction.
- Anticipation of needs. The health system should anticipate patient needs, rather than simply reacting to events.
- Continuous decrease in waste. The health system should not waste resources or patient time.
- Cooperation among clinicians.
Clinicians and institutions should actively collaborate and communicate
to ensure an appropriate exchange of information and coordination of
care.
Mike builds on these principles and rules to suggest
specific improvements to Canada's health-care system, at the community
level, in each of these eight critical healthcare system stress points:
- Treatment for the terminally ill
- Treatment for chronic illnesses
- The role of home and continuing care
- The role of long-term care
- Illness and disease prevention and emergency preparedness
- Access to caregivers, and patient-caregiver teamwork
- The role of drugs
- Dealing with wait times
The
recommendations are extensive, well-considered, practical, innovative,
not difficult to implement, and illustrated with examples of where they
have been successfully used.
Now all we need is to get communities
networked together and working on these recommendations, and sharing
their experiences with other communities. While the nature of the
different regulatory and organizational environments between countries
must be considered, the challenges of the system and the needs of
patients and caregivers are similar everywhere, and there are
extraordinary opportunities for communities to learn and help each
other worldwide.
The biggest challenge, it seems to me, is the lack of autonomy
of the community-based heathcare providers and systems, their ability,
once they have had 'aha' moments and identified improvements they
intuitively know will work, to actually implement them, free from
top-down and bureaucratic interference. Nothing could be more
discouraging than knowing what you need to do, and not being allowed to
do it. That, and, for Americans, dealing with the infuriating and
pervasive Moral Hazard Myth. |
1:34:27 PM 
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MADE IN CANADA
trust your
instincts 
