Real Evidence Bites Back

Lawyers are taught never to ask a question on cross-examination if they don’t already know the answer.  They are also taught never to rely on a case to support an argument if it also includes statements that can turn around and bite you.  It is clear that Ken Hughes, Chairman of the Board of Alberta Health Services, is not a lawyer.  Mr Hughes wrote a letter to the editor (Dec 26,2010 Calgary Herald) taking issue with a comment made by David Taras, a political scientist.  Mr Taras said that the health care system under Stelmach was collapsing.  Mr Hughes flew into high dudgeon, asking “Where is the evidence to substantiate such an offhand, sweeping statement? Having dismissed Mr Taras one would expect Mr Hughes to dazzle the reader with persuasive evidence that there is no health care crisis.  So what did Mr Hughes say?

First he starts with the obvious:  Alberta was hurt by the global recession, the population is aging, the population is growing, new treatments and technologies cost money.  This is not evidence in support of a good (or even a mediocre) health care system, but a list of excuses for a poor one.  Mr Hughes also tries to twist the argument away from a lack of confidence in the health care system to a lack of confidence in the health care providers.  He says “We are proud of the work of all of our health-care providers and confident in their skills and commitment. Albertans can and should be confident as well.” Mr Hughes may be surprised to learn that Albertans haven’t lost confidence in their health care providers;  they’ve lost confidence in the health care administrators, namely the AHS, and their political masters.

The heart of Mr Hughes’ argument rests on the Health Quality Council of Alberta (HQCA) report: 2010 Measuring and Monitoring for Success, which he says “…demonstrated that while patients have concerns, they have not lost confidence in the system nor think there is any reason to think, again based on the evidence, that they believe the system is collapsing.” I just finished reading the report and wonder:  Did Mr Hughes actually read it?

The report is well written and well researched.  Its theme is the power of measurement and its use in improving the quality and sustainability of health care.  The report addresses the role of innovative information management.  The only comments that have the slightest bearing on Mr Hughes’ argument arise in the context of accessibility:  48% of Albertans rated access to health care services as easy and 54% who visited the emergency department rated access as easy.  The response rate was 38%.

The report did not ask Albertans to comment on their confidence in the system or whether they think it’s collapsing—hardly surprising given that thesurvey was conducted from Feb 24 to May 11, 2010.This was 5 months before Dr Parkes wrote to the Premier and the Health Minister expressing his deep concern about the fragility of the health care system and warning of a “potential catastrophic collapse”.  The Parkes letter ignited a public debate that has raged ever since.  For Mr Hughes to assert in Dec 2010 that Albertans have confidence in their health care system based on the results of a survey conducted in Feb/May 2010 is, at best, disingenuous.

Mr Hughes suggests that the “crisis” is political rhetoric and not a honest assessment of the system today.  This is the “turn around and bite you” part.  The HQCA report concludes that:  “Alberta’s $15-billion per year health care system does not measure its primary output (restoration or maintenance of functional health) or the cost of that output (cost per clinical outcome) in order to systematically assess value and potential sustainability.  As such, it is difficult to understand system-level cost drivers in each health care sector—drivers that can help explain what increases costs after general inflation, population growth, and aging have been taken into account. In other words, no one knows what’s going on.

One might conclude that it’s not just the people of Alberta who lack confidence in the state of health care in the province, it’s also the HQCA.  One might also conclude that the real reason why Mr Hughes did not provide any compelling evidence in support of his argument is that there isn’t any.

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