Canada needs ‘coalition of the willing’ to improve health care

Theglobeandmail.com
Nov. 17, 2015
By Andre Picard

What country has the world’s best health system? That is one of those unanswerable questions that health-policy geeks like to ponder and debate.

There have even been serious attempts at measuring and ranking. In 2000, the World Health Organization (in)famously produced a report that concluded that France had the world’s best health system, followed by those of Italy, San Marino, Andorra and Malta.

The business publication Bloomberg produces an annual ranking that emphasizes value for money from health spending; the 2014 ranking places Singapore on top, followed by Hong Kong, Italy, Japan and South Korea.

The Economist Intelligence Unit compares 166 countries, and ranks Japan as No. 1, followed by Singapore, Switzerland, Iceland and Australia. The Commonwealth Fund ranks health care in 11 Western countries and gives the nod to the U.K., followed by Switzerland, Sweden, Australia and Germany.

The problem with these exercises is that no one can really agree on what should be measured and, even when they do settle on measures, data are not always reliable and comparable.

“Of course, there is no such thing as a perfect health system and it certainly doesn’t reside in any one country,” Mark Britnell, global chairman for health at the consulting giant KPMG, writes in his new book, In Search of the Perfect Health System.

“But there are fantastic examples of great health and health care from around the world which can offer inspiration.”

As a consultant who has worked in 60 countries - and who receives in-depth briefings on the health systems of each before meeting clients - Mr. Britnell has a unique perspective and, in the book, offers up a subjective and insightful list of the traits that are important to creating good health systems.

If the world had a perfect health system, he writes, it would have the following qualities: the values and universal access of the U.K.; the primary care of Israel; the community services of Brazil; the mental-health system of Australia; the health promotion philosophy of the Nordic countries; the patient and community empowerment in parts of Africa; the research and development infrastructure of the United States; the innovation, flair and speed of India; the information, communications and technology of Singapore; the choice offered to patients in France; the funding model of Switzerland; and the care for the aged of Japan.

In the book, Mr. Britnell elaborates on each of these examples of excellence and, in addition, provides a great precis of the strengths and weaknesses of health systems in 25 countries.

The chapter on Canada is appropriately damning, noting that this country’s outmoded health system has long been ripe for revolution, but the “revolution has not happened.”

Why? Because this country has a penchant for doing high-level, in-depth reviews of the health system’s problems, but puts all its effort into producing recommendations and none into implementing them. Ouch.

“Canada stands at a crossroads,” Mr. Britnell writes, “and needs to find the political will and managerial and clinical skills to establish a progressive coalition of the willing.”

The book’s strength is that it does not offer up simplistic solutions. Rather, it stresses that there is no single best approach because all health systems are the products of their societies, norms and cultures.

One of the best parts of the book - and quite relevant to Canada - is the analysis of funding models. “The debate about universal health care is frequently confused with the ability to pay,” Mr. Britnell writes. He notes that the high co-payments in the highly praised health systems of Asia would simply not be tolerated in the West.

But ultimately what matters is finding an approach that works, not a perfect one: “This is the fundamental point. There is no such thing as free health care; it is only a matter of who pays for it. Politics is the imperfect art of deciding ‘who gets what, how and when.’”

The book stresses that the challenges are the same everywhere: providing high-quality care to all at an affordable price, finding the work force to deliver that care and empowering patients. To do so effectively, you need vision and you need systems.

Above all, you need the political will to learn from others and put in place a system that works.