Dr Duckett may be gone but he won’t soon be forgotten. In his farewell speech to senior AHS staffers he set the record straight with a number of provocative comments. The most significant of which was this: “Alberta spends more per capita (adjusted for age and sex) than other Canadian provinces and gets less”. Is this really true? If so, does that mean that there is no direct relationship between healthcare spending and the quality of healthcare service?
Bingo: It’s not how much you spend, but how you spend it.
CHCI data shows that in 2010 Alberta spent $4295 per capita on healthcare but ranked #7 in healthcare performance. Ontario and BC, which ranked #1 and #2, spent $3547 and $3543. Let’s just call it $3545 even. That’s $750 less per person than Alberta. But Ontario and BC succeeded in being the top ranked provinces in healthcare performance—for three straight years.
One reason for this perverse outcome is that greater spending doesn’t guarantee greater value. In fact if an organization refuses to measure its outcomes, the value equation is completely meaningless. Dr John Cowell, CEO of the Health Quality Council of Alberta, believes that Alberta’s healthcare system does not adequately measure the output (good health) or the cost of that output (cost per clinical outcome). Consequently it cannot systematically assess value or sustainability. In other words Alberta taxpayers are throwing a lot of money at this problem–$15 billion to be exact—but the government and AHS have yet to figure out how to get the best value for those tax dollars and the people of Alberta continue to suffer.
The non-relationship between healthcare spending and healthcare performance also plays out on the global stage. The Euro-Canada Health Consumer Index (ECHCI) 2010 ranks Canada’s healthcare performance at 25th out of the 34 countries surveyed. And yet with a per capita spending rate of $3662, Canada is one of the highest per capita spenders in the group. Only 3 countries outspent Canada. They are Switzerland (ranked 5th) Luxembourg (ranked 8th) and Norway (ranked 11th), all performed significantly better than Canada at #25. Twenty-one countries spent less than Canada but still outperformed it in healthcare delivery.
Given that Canada’s and Alberta’s healthcare problems do not stem from a lack of money, it is unlikely that throwing more money into the healthcare budget will improve the situation. So what will help? Before we busy ourselves with sharing best practices and learning from others, let’s be frank about what is getting in the way of delivering good performance.
Cue Dr Duckett. The ex-CEO’s speech is laced with comments alluding to the problems created by continual political meddling and missteps. He notes that “The media along with politicians only see the short term and often fail to connect the dots” and that “ The AHS operates in a politically charged environment.” He describes the government’s failure to provide adequate funding for long term and non-acute care facilities which exacerbated the ER crisis and notes, rather pointedly, that the government failed to keep its commitment to fund universities and colleges to graduate 2000 nurses a year and that further funds are needed to train 1000 health care aides a year in order to truly transform the workplace.
This brings me to the ECHCI discussion about the Netherlands which ranked #1 in performance in 2010 and has ranked in the top three since 2005. In addition to the organization of its healthcare insurance system (a topic for a future discussion) the authors note that the Netherlands healthcare system has removed politicians and bureaucrats from key decision making processes, leaving the operative healthcare decisions to the medical professionals. They state that politicians and bureaucrats seem to be further removed from these decisions in theNetherlands than any other country in the indexand argue that this is “an important reason for the Netherland’s outstanding performance.”
So taking a cue from Shakespeare (but without the fatal consequences) might I suggest that the first thing we do is get rid of the politicians and let the medical professionals make the operative healthcare decisions. Surely they wouldn’t do any worse.