Action Points for Healthcare Reform
In June 2013, on the eve of the first Queen’s Health Policy Change Conference, more than 40 Canadian healthcare leaders and international experts gathered in Toronto to discuss healthcare reform. The Queen’s Roundtable for Healthcare Reform was organized by the Queen’s Faculty of Health Sciences, School of Policy Studies, and The Monieson Centre for Business Research in Healthcare at Queen’s School of Business.
Roundtable participants agreed on a number of key priorities and advanced ideas on how to move healthcare reform forward.
The Queen’s Roundtable for Healthcare Reform identified key priorities, barriers to change, and action items for policy-makers and healthcare players to consider.
Areas of agreement
Participants at the Roundtable reached broad consensus on several strategic priorities for healthcare reform in Canada. The priorities, suggested by Don Drummond, Matthews Fellow in Public Policy at Queen’s School of Policy Studies, include:
- a shift towards more patient-centric care beyond hospitals, especially related to chronic conditions;
- the need for holistic views of healthcare that involve prevention in addition to treatment, better integration across the continuum of care, and recognition of the socio-economic dimensions of health;
- introduction of dedicated healthcare channels for the resource-intensive minority;
- pre-agreements on end-of-life care;
- extensive use of information technology; and
- revised funding models that blend base funding with pay-by-activity for hospitals and that move towards outcome-based funding for all healthcare providers.
Other areas of agreement:
- Changes in the healthcare system require an understanding of the emerging roles of health providers and changing scopes of practice. Physicians should be engaged in an objective review of the role of physicians and hospitals.
- Patients must be involved in the process of reform.
- To move beyond talk to action, the focus should be placed on impediments to change and definitive strategies for moving forward.
- The healthcare sector should give government the “courage to do what’s right.”
- There needs to be a shift from viewing healthcare as a burden to an asset, and then learning how to realize “return on investment.”
Barriers to Change
Roundtable participants agreed with the seven key impediments to change outlined by Dr. David Walker, former Dean of Health Sciences at Queen’s University.
- Political reticence and the false Canadian perception that our healthcare system is better than it actually is
- A system that isn't equipped for the increasing need for chronic care, since it was designed around acute care
- The autonomy of doctors and clinical variations
- A system that rewards processes rather than outcomes
- Information systems that prevent Canadians from accurately measuring health outcomes
- Federal-provincial/territorial structure that confuses who has authority for what, despite the Canada Health Act
- Unconditional federal funding
Additional key points regarding obstacles to healthcare reform:
- The biggest challenge is the process of change.
- A common dialogue shared among Canadians is needed, similar to what came about in New Zealand and other countries.
- Reform carries great political risk; governments need courage as well as the support of associations, practitioners, and patients.
- Canadians need to shift from a “zero-sum game” perspective.
- There is an austerity/transparency divide.
- Can we shift from a “sickness system” to a “health system” by focusing on the determinants of health?
The Way Forward
Ideas and insights were advanced on how to move healthcare reform forward in Canada.
- Clarity of purpose is critical and may encourage the private sector to come alongside the public sector.
- Private sector investment can be seen as an enabler to change.
- Investment in information technology is critical.
- A combination of approaches employing multiple complementary interventions works best.
- There is room for experimentation.
- A sustained, structured, longitudinal approach is needed.
- Consider including prevention initiatives (smoking bans, for example, have been effective in Canada and elsewhere).
- There are opportunities for leadership outside the political sphere.
- Fine-tune the incentives for healthcare providers.
- Look at innovation elsewhere, including the United States. Lessons can be imported. Denmark, for example, focused on three core areas of change: efficiency, structure, and intersection with policy.
- Focus on quality and outcomes.
- Engage leadership from the next generation, especially through students.
- Discuss social care, mental health, and housing.
— Adapted from Queen’s Roundtable for Healthcare Reform: Summary