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Bring in patient-centred health care

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18Mar

By: Graham Lane

Posted: 3/18/2016

Part of Canada’s successful global brand is our single-payer public health-care system, which guarantees access to free health care to all. While being free at point of use it is an expensive system, paid for by taxpayers. Experts agree it may not be sustainable over the longer term.

Compared to other developed industrialized countries, Canada’s health-care spending is among the highest, costs being 32% higher than the OECD average. Manitoba’s health-care spending, now around 40% of the budget, tops out close to being the highest in high-spending Canada. No surprise after 17 years of out-of-control NDP spending. As with the education system, somehow the Selinger government has, rather dismally, managed to combine high health-care expenditures with some of the worst health-care outcomes in Canada — including the country’s longest emergency room waiting times.

Politicians across Canada continue to play safe by shovelling new money into chronically bureaucratic low-performing monopoly systems of health-care delivery. But, the price of catering to our expensive provider and union-dominated health-care model, particularly in NDP Manitoba, is enormous. In 2014, according to the Canadian Institute for Health Information, Manitoba spent $5,000 per person on health-care, $739 per person higher than the national average. If Manitoba, with a political class that oddly seems to revel in the averageness of this province, just spent at the Canadian health-care average we would save about $940 million dollars a year, more than enough, for example, to end both payroll tax and the school portion of property taxes.

At some point, surely there should be limits to spending increases, taxing, and excess borrowing to support a system providing overall mediocre results to patients and citizens. Instead of having a system designed to meet the needs of the delivery apparatus, the system needs to be redesigned to put patients’ needs first.

The next provincial government should begin by studying European models of health-care provision. Some answers lie in a 2010 Frontier Centre study. Frontier co-partnered with Swedish researchers to benchmark Canadian patient outcomes and spending against 34 European countries. Canada scored 25th despite being the highest spender.

The study notes that high-performing health-care systems countries, which generally have single-payer, free at point of use systems, achieve much superior patient and taxpayer outcomes than ours, this due to two basic differences from the lower-performing Canadian system.

First, the top performing single-payer European models broke the delivery monopoly by separating the provider and funder functions of health-care services (known as the purchaser-provider split). Consumers choose to use either public or private clinics, which, in turn, bill a central purchasing authority for services rendered. Second, funding follows the patient, which means no global budgeting where hospitals simply get funded with a block grant irrespective of volumes of services provided — which still remains the Canadian way.

To give Rana Bokhari full credit, the Manitoba Liberals have proposed to dip the sclerotic Manitoba health-care system’s toes into test funding knee surgeries employing the European activity-based funding model. Done properly, it would eliminate waiting lists in this area.

It would be just a start. Trying new proven methods requires leadership. Both patients and taxpayers would benefit immensely upon Manitoba adopting European best practices in health-care reform.

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