Fwd: qotd: Lessons from British Columbia

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-------- Original Message --------
Subject: qotd: Lessons from British Columbia
Date: Mon, 14 Apr 2014 04:27:05 -0700
From: Don McCanne <don@mccanne.org>
To: Quote-of-the-Day <quote-of-the-day@mccanne.org>



Surrey Now
April 8, 2014
Health-care changes seem to be paying off in B.C.
By Keith Baldrey

Have we finally wrestled that voracious gobbler of tax dollars - the
public health-care system - to a standoff, if not to the ground? By that
I mean the days of the system automatically devouring increasingly large
amounts of money every year to feed itself may be drawing to a close, at
least in British Columbia.

Of course, I don't mean the health-care system will stop being the
biggest area of government spending by far (the health-care budget this
year is pegged at $16.9 billion, out of a budget of $44.4 billion).

But the rate of growth in spending is slowing down significantly. The
annual hike is down to 2.6 per cent this year, compared to just several
years ago when it was above five per cent.

Now, there are those who think this is bad news. After all, shouldn't we
be plowing even more money into the system rather than less? If we
don't, won't health-care standards suffer? The answers are: a) not
necessarily and b) no.

The ideological defenders of the public health-care system (who think
the answer to everything is to blindly spend gargantuan amounts of more
money) think the only measuring stick worth anything is per capita
spending. In other words, B.C. should spend more dollars per person than
anywhere else, and things will take care of themselves.

But those with experience in the system, who study it and come up with
good ideas for change, point to another and far better measurement:
health outcomes.

And in that regard, B.C. ranks the highest in the country. While we sit
second-to-last in per-capita spending, (only Quebec ranks lower) we beat
most other provinces in all kinds of areas: best cancer survival rates,
lowest heart attack rate, longest life expectancy, lowest smoking rate,
lowest infant mortality rate, etc.

When it comes to wait times for certain surgeries (an admittedly
frustrating situation for many people on those wait-lists), they've been
mostly going down and not up. The median wait time for a hip joint
replacement has declined to 13 weeks from 19 weeks over the last 10
years, while a knee joint replacement has gone from 25 weeks to 18 weeks
over the same time period.

None of this is to suggest the health-care system does not need constant
up-keeping and reform (crowded emergency rooms, for example, seem to be
a chronic problem, and we could always use more nurses). But it is
encouraging that blind yearly spending hikes are being replaced by
newer, innovative ways of spending that are both efficient and lead to
healthier outcomes for the users of the system.

Not being able to count on big increases in funding every year has
brought some much-needed discipline to the system, and employing some
different models has also helped.

One of the most significant changes that is paying off is the
government's relationship with doctors.

In the past, physicians were viewed as costly, self-interested cogs in
the system.

Now, however, they are viewed as equal partners who have real
responsibilities when it comes to running the health-care system.

For example, several joint committees have been established with the
Doctors of B.C. (formerly called the B.C. Medical Association) where
doctors and the government shape policies that are aimed at improving
patient health, rather than protecting the financial interest of either
party.

One committee is for general practitioner services (overseeing
improvements to the primary care system), another is for specialist
services (aimed at improving access for specialist care) and a third is
for shared care (focused on better integration of all levels of care).

As well, something called the Divisions of Family Practice has been
created. It links family doctor practices and is designed to improve
common healthcare goals in a particular region (improved maternity
coverage, for example).

Committees such as these were unheard of a decade ago. They appear to be
improving patient care by focusing on smart, evidence-based decisions
rather than on simply demanding more money, either for doctors' pay
packets or a health authority's budget.

The Canada Health Accord between the provinces and the federal
government died last week. It means Ottawa will be cutting in half its
annual transfer of money to pay for health care.

The fact the B.C. government hardly said a peep about the accord's
demise is evidence of how much the system has changed in the past few years.

http://www.thenownewspaper.com/opinion/baldrey-health-care-changes-seem-to-be-paying-off-in-b-c-1.946815

****


Comment by Don McCanne

Evidence based health care. Why should that be controversial? Yet it is.
It provokes accusations of "cook book medicine," or "bureaucrats
interfering with your health care." Current efforts in British Columbia
can provide us with a more rational perspective than is being provided
by these negative memes.

Physicians from the B.C. medical association (Doctors of B.C.) and the
government are cooperating on efforts to improve patient health in
manners other than by simply increasing spending (though that should not
be neglected when there is an obvious imperative). Such efforts to spend
better rather than simply spending more will be particularly important
now that the federal government is being run by individuals who promised
to protect Canada's medicare but instead cut federal spending on the
program in half.

Although single payer systems are often criticized for being bogged down
by government inflexibility and laggardly progress, the activities in
B.C. demonstrate that such processes need not be an inevitability. In
fact, B.C. is showing us that their single payer system does have the
flexibility to make needed improvements.

In the United States we are currently using models, such as accountable
care organizations, supposedly to achieve higher quality at a lower
cost. Unfortunately, the model seems to have been misdirected away from
efforts to improve health care based on evidence to efforts granting
nominal awards based on penny pinching and a few negligible
teach-to-the-test measures. Under our fragmented, multipayer system it
is difficult achieve widespread adaptation of systemic improvements,
simply because it is our unique, dysfunctional financing system that is
so inflexible.

This is not to belittle the efforts of AHRQ toward expanding the use of
evidence based medicine. Rather it is to make the point that government
efforts such as those of AHRQ can be more effective if we get the
dysfunctional financing system out of the way, especially the intrusive
private insurers, and allow AHRQ and other public entities to cooperate
more effectively with the people actually delivering health care.