Comparative Health Systems and Canadian Reform

Last month, I had the privilege of presenting on the subject of Comparative Health Systems at the Physician Hospitals of America conference in New Orleans. I’ve been an armchair student of international health policy for many years, but this was the first occasion that I had to present on the subject.

The challenge of presenting on health policy to an audience currently undergoing some of the grandest health system change in history was somewhat overwhelming, particularly to an audience of doctors and senior healthcare administrators.

My co-presenter, Dr. Nigel Murray, and I chose to look at Sweden, UK, New Zealand and Canada. We looked at very specific aspects as it related to the health reform initiatives under way in the US, including insurance coverage systems, public/private delivery, government intervention, and medical malpractice compensation systems in each of these countries.

The irony of having two Canadians presenting to this audience was not lost on me. Canada is the only OECD country to have a fully universal, publicly funded system. It is also the only country not to have undergone any major health reform in 25 years. And here we were, talking about comparative health systems and how they have evolved to meet the demands of their populations.

I would not do the reader justice to try to summarize the comparative health delivery systems here in a blog; suffice to say that while there are no “perfect” systems, Sweden, the UK, New Zealand and now the US have all entered the era of health reform. Each system has, or is, undertaking reform in an iterative process, enacting changes and not fearing the need for further change.

Which leads to the purpose of this posting. When President Obama initiated reform in the US, he took a bold step towards dramatic system change. Coverage, compensation schemes, the regulation of providers, and addressing the shortage of medical professionals are all on the table. The principles he put forward for this change will be the foundation for the greatest change in the history of the US. He’s staking his career on it.

Back in Canada, our 25 year old Canada Health Act continues to bump along. At the time that it was brought into legislation, tying the hands of all provincial governments to publicly funded and publicly delivered care (although that is subject to interpretation), no one could have envisioned the challenges and advances that would take place in healthcare. And now we have provincial governments faced with short term financial pressures looking to cut funding to population services – the largest of which is healthcare.

Canada needs to look at serious health reform. Politicians at both the provincial and federal levels need to have the courage and insight to create large-scale reforms of the Canadian system. It won’t be popular – as President Obama has certainly learned – and it may not even be right the first time. However, as our systems approach 50% of all provincial government spending, we are on the path to bankruptcy. We need to look at how other systems have reformed, what it has produced in terms of successes, failures, and sustainability. This steep learning curve should not be lead by bureaucrats who are married to the current system and rebuke change; we need learned people who can put their ideologies aside and understand the sense of urgency required.

Now that would be something worth holding an election over.