An injection of cash into the health-care system might make Canadians feel better in the short run, but there will be no long-lasting benefits unless there is a mechanism to make sure some of the money gets spent on information and communications technologies a report warned.
According to Health
Care System Sustainability – Understanding Health System Performance of Leading Countries, produced by the Conference Board of Canada, Canada ranks 13th in overall performance among 24 OECD countries.
Switzerland, which has an expensive, private system, came first, while Sweden, whose system is publicly funded, came second.
That means the solutions politicians continue to suggest — namely more money and either more or less privatization, depending on the party — are way off track, said CBOC director of health programs Glen Roberts.
“”Maybe we don’t have the strong and dedicated leaders willing to make tough decisions and focus on the critical issues; maybe we need a workforce that continues to be dedicated, flexible and motivated, and yet is still willing to accept decisions to balance their own objectives with the public interest,”” Roberts said. “”We reached the conclusion that perhaps the system does need more money, but it also needs to enhance its management practices.””
There clearly is a disconnect between what the public is prepared to spend versus what it is they want. Roberts added. “”If Canadians expect that level of service, there is a price to be paid, and at this point, based on evidence we’ve seen at the board, there doesn’t appear to be a willingness to have higher taxes to support a better health care system,”” he said.
The report is a follow-up to the March 2004 study the board did on understanding health-care cost drivers. Both are available as a free download from the board’s Web site.
And while the board is recommending Canada increase its IT spend in health care to at least four or five per cent, up from the current 1.8 to 2.5 per cent, simply increasing IT spending won’t solve the problems either, he said.
“”I think the real issue in particular in Ontario is governments are not funding ICT as a line item,”” Roberts said. “”They give hospitals global budgets and they hope they have the strength of conviction. I sat on a hospital board not that long ago where we were confronted with this tough decision – do we buy an expensive computer or do we keep our nurses? It’s a very challenging leadership question boards have to struggle with, which ultimately staffs have to struggle with.””
For example, only 40 per cent of Canada’s hospitals are connected to the Internet. Most of those that are connected, he said, are likely to be large facilities in urban areas with flexible enough budgets.
According to the report, commitment to ICTs translates into the availability of electronic health-care records to every health-care provider dealing with a patient, theoretically leading to better co-ordination of services and a higher quality of care. But that effort in Canada has been seemingly disjointed, with Canada Health spearheading the federal initiative, while several provinces are working on their own and a number of health care organizations have developed their own versions to use for their patients.
“”What has happened is there has been a large investment into Infoway and they’ve struggled with the jurisdictional issue,”” said Roberts. “”Maybe that struggle has led to a little disconnect and regionalization around some of these projects.””
Bernard Courtois, president of the Information Technology Association of Canada, said the health care system in Canada is run like the private sector was about 15 years ago – which means it’s seriously outdated.
Car owners get superior care for their cars, as do pet owners when they go to a veterinary clinic – both those industries have been using electronic records for quite some time, he says.
“”When you go into a car dealership with your car, no matter what city you’ve bought it in, they’ll plug it in and instantly have access to everything that has been done to it and what’s needed, and we don’t do that for human beings,”” says Courtois. “”We don’t want to poke our nose into federal-provincial relations … but we just thought it was very important to signal to everybody that we’re under-spending on something that would improve the performance. Studies of individual use of ICTs in health show you shorten waiting lists, you allow doctors to treat more patients, and you reduce errors.””
Courtois said the current system of funding hospitals only serves to make planning for the future a near impossibility.
“”Hospital CIOs can be quite frustrated because they’re not given a budget, so if they want to invest for the future they have to cut back on something today, so there’s an inherent obstacle in the system to improving it for the future,”” he said. “”That’s why many of these decisions have to be led from the top at the provincial level. They’ll (the provinces) have to decide we’ll set aside a certain amount of funding so we will get the benefits down the road.””