What's Wrong with Healthcare?

Thinking inside and outside of the healthcare box. After 41 years of family practice, what's happened to Canada's healthcare system?

Friday, April 21, 2006

Innovation, Canada's "American Inventor"

It must be tough to be a Provincial Health Minister; sort of like a worm on the Canada Health Act hook. No matter how much you wriggle and squirm, there is no getting off of it, so it would seem. Alberta is back to the “innovation” stuff and eight other parts of “the third way” that has been put forward for the past 15 years. The “contentious parts” like doctors practicing in both the private and public sector will be scrapped. After all, apparently Dr. Noseworthy (health Policy division at the University of Calgary) has termed that idea both disastrous and ludicrous. Now, I’m not sure how much medical practice Dr. Noseworthy has actually done, especially in the last 15 years (it would have been nice if the news media had commented on that), but after 40 years of practicing and being actively involved in the “innovation” process, I believe his comments, if accurately quoted, are disastrous and ludicrous.
There is no question that this whole innovation thing started some 15 years ago, and was driven primarily by a shortage of government revenues. Provincial and federal governments were going deeper in dept, and the federal government was being more aggressive in decreasing transfer payments for health and education to the provinces. As mentioned on previous blogs, Baer and Stoddard (with no facts to back them) had come out with a report that labeled physicians as a special interest group, and one of the main causes of escalating health care costs. Provincial governments saw this as an ideal time to bring about “reform” and “innovation”. I remember at the time, calling our premier “Mr. DeKlein”, who ran around crying “The sky is falling, the sky is falling!”. Nevertheless, since that time (at least 15 years), the buzz words in our health care system have been “reform” and “innovation”. Since that time the “at risk lists” and emergency department “wait times” have been steadily increasing (in spite of many committees, focus groups, incentive money, etc); not a ringing endorsement of innovation and reform so far. So what makes us think that another dose of the same medicine is going to do any good?
The original time and place for innovation was completely wrong. If you read the literature on innovation, there are two principle requirements-----an abundance of money and a “buy in” on the part of the participants. This did not exist 15 years ago. The governments were short of money, and since physicians were seen as the enemy, they weren’t about to jump into bed with governments and overhaul a system that they felt was working quite well.
Although I almost never watch “American Inventor” (a new T.V. reality show), I think our Health Ministers in Canada should. There are some valuable lessons to be learned:
First, most every inventor (you can substitute innovator) has made considerable financial and personal sacrifices over a significant period of time, to come to the point of presenting their invention.
Secondly, each inventor believes fervently (like a religion), that their idea is the best in the world and will win the major prize.
Thirdly, the presenters simply cannot and will not be convinced of the fallacies in their “visions”.
And finally, fourthly, an extremely small percentage of the inventions (innovations) are worth considering. Most of the presentations have humor appeal only.
So we will keep going down this road in health care. We will continue to prescribe an antibiotic (innovation) for this viral infection even though we can see the patient continues to worsen. Physicians are now ready for true reform and innovation, the news media is not. The news media seem to thrive more on disasters than successes, physicians on successes rather than disasters. Little wonder we don’t see eye to eye on health matters.
The Alberta government is now at a stage where true innovation could take place. We do have the finances to do some incredible things in health care reform, but we need to have the handcuffs and leg irons of the Canada Health Act removed. Micromanagement and the Canada Health Act have been the jail keepers for the last fifteen years and have called any thinking outside of “jail” and any true innovation, ludicrous and disastrous. Mr. DeKlein eventually had the right idea, but not enough courage and conviction. Unfortunately, Alberta is back to politics as usual, and that means “using health care to get elected” (along with the usual weasel words), instead of being a leader in the field of health care.


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