Evidence of meeting #78 for Health in the 41st Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was innovations.
A recording is available from Parliament.
4:30 p.m.
Head, Radiation Physics Department, Princess Margaret Cancer Centre
It would be something that lets us exchange the value across the system. Then you would have innovators driving it and working together. This is the part we're missing. We're realizing that we need process.
I won't speak to what Pascale will say—
March 7th, 2013 / 4:35 p.m.
Conservative
Colin Carrie Conservative Oshawa, ON
You just got the NDP all excited about the possibility of a carbon tax.
4:35 p.m.
Voices
Oh, oh!
4:35 p.m.
Canada Research Chair on Innovations in Health, Professor, Department of Health Administration, Université de Montréal
I guess I both agree and disagree with what has just been shared by my colleague.
I agree that there are many connections between academia and industry, but also health care players are connected in many ways. I sit on the board of IHSPR, which is one of the 13 CIHR institutes close to health services and policy research. That institute has worked quite a lot in the past ten years to create those connections with policy-makers, decision-makers, and getting the evidence out there in the system.
So there are plenty of connections, and I don't think we need more. I think we need to be able to sit down together, talk together, but we are good at doing stuff that we are good at doing, respectively.
The point on which I disagree is that I don't believe the U.S. is the model for Canada, or not in terms of innovation development strategy. The venture capital that we don't have in Canada, as the data have shown, often means that we lose a lot. We don't gain out of that game so much, and I don't think we will be on top of that game in the near future, because we don't have a similar kind of tissu industriel. We don't have the same type of businesses in the country.
I don't feel we need to look at the U.S. as a model to replicate.
4:35 p.m.
Head, Radiation Physics Department, Princess Margaret Cancer Centre
I just want to be clear that I'm not supporting that we adopt the American health care system. When I worked there, it was very clear to me that if we were going to introduce a new technology to the hospital, I had to go to the board and demonstrate 15% return on that capital investment. That was a business decision that made us analyze very carefully the impact of that technology, how we were going to process technology, what it meant to our environment and to our partners.
That economy, which is active at the lowest level in American health care, is something that we're missing. I'm not saying we should drive it by dollar. We could drive it by efficiency, we could drive it by performance, we could drive it by quality, we could drive it by safety, but we need that economy of innovation to pull in the technological and pharmaceutical opportunities we have.
4:35 p.m.
Conservative
Colin Carrie Conservative Oshawa, ON
I would think too that we have to start measuring what we're doing. I was surprised by your comment, Dr. Hoch. I think you said we should be investing in research to determine its value. In other words, if we have a protocol and your expertise is in cancer, we're looking at a cancer protocol that we're using now, and then we have a new drug. Maybe there should be ways we can measure new protocol versus old and then we can make an economic decision—actually a quality decision. Whatever the quality, you want to use that as a driver.
Do you have any data that suggests that maybe, when doing all these things in the Canadian health care system, we're doing a bunch of stuff that's not working? I've heard in the past that we get into these little grooves and we keep doing the same thing over and over again, but we're maybe not getting the best bang for the patient in these protocols we're using to treat people.
Do you have data that's looking at protocol a versus protocol b? If we're not doing that, why do you think we're not doing it, and how can we start doing it?
4:35 p.m.
Director, Cancer Care Ontario, As an Individual
I think that's a very smart way to go about using cost-effectiveness analysis: find things that aren't helping people and that we pay a lot for, and try to do less of them.
One of the challenges in health care is that after you say yes and start paying for it, it is very difficult to bring that back in.
4:35 p.m.
Conservative
The Chair Conservative Joy Smith
Thank you so much.
We'll now go into our second round. I'm sorry, Dr. Carrie, but time is up.
4:40 p.m.
Conservative
The Chair Conservative Joy Smith
I know you were. You can hold that thought and carry on in our next round. How's that?
We'll go into our second round, which is five minutes, so you will have to be a little more conscious of time. We are going to suspend at 5:15.
We have 35 minutes and we'll begin with Dr. Sellah.
4:40 p.m.
NDP
Djaouida Sellah NDP Saint-Bruno—Saint-Hubert, QC
Thank you, Madam Chair.
I would first like to thank all the witnesses who are here today for their relevant presentations.
My question is for anyone who can answer it.
There are numerous academic, government and hospital-based organizations and agencies that undertake health technology assessments (HTAs) in Canada. The Canadian Agency for Drugs and Technologies in Health (CADTH) is a non-profit organization established by the federal, provincial and territorial governments in 1989 to ensure that policy makers have access to evidence-based assessment of the clinical and cost effectiveness of pharmaceuticals and health technologies.
How does the work undertaken by CADTH differ from that of other health technology assessment organizations in Canada? Furthermore, in your view, what steps could CADTH take to coordinate efforts in health technology assessment in order to avoid duplication of efforts and possible inefficiencies in this area? Finally, in your view, are policy makers more likely to adopt the recommendations made by CADTH regarding funding decisions for drugs and technologies, or are they more likely to adopt the recommendations made by local health technology assessment organizations?
Thank you.
4:40 p.m.
Conservative
4:40 p.m.
Canada Research Chair on Innovations in Health, Professor, Department of Health Administration, Université de Montréal
Yes, I could.
Thank you for your question.
A few years ago, I studied the assessment organizations in the provinces and across Canada. In terms of duplication, I can assure you that these organizations work together, they meet and get together on a regular basis. The last thing they want is to have to redo a study that another organization has already done. So that should not be a concern.
I think the question about the national and provincial cooperation is more complex. Provincial agencies have forged special ties with policy makers under their jurisdiction. The national agency's position has always been against making recommendations, for the simple reason that health falls under provincial jurisdiction. So its opinions are consulted and reviewed, but the responsibility for the decision is in the hands of the policy makers.
4:40 p.m.
NDP
Djaouida Sellah NDP Saint-Bruno—Saint-Hubert, QC
So that is the responsibility of the policy makers in each province. Okay.
That is why pCODR is a good example. I noticed that Quebec was not included.
4:40 p.m.
Canada Research Chair on Innovations in Health, Professor, Department of Health Administration, Université de Montréal
I will let my colleague Jeff answer that.
4:40 p.m.
Director, Cancer Care Ontario, As an Individual
Could I ask for the question again, and how much time do we have?
4:40 p.m.
Director, Cancer Care Ontario, As an Individual
Could you take a long time asking the question again?
4:40 p.m.
NDP
Djaouida Sellah NDP Saint-Bruno—Saint-Hubert, QC
Ms. Lehoux partly answered the question by saying that it was up to the policy makers in each province to make the decisions.
Let me ask you another question. In your view, how effective has CADTH been in disseminating the findings of its research to policy makers, health care providers and other HTA organizations across Canada?
4:40 p.m.
Director, Cancer Care Ontario, As an Individual
I think CADTH does a good job communicating. The challenge is that with devices, the payer or customer is often the hospital. So even if CADTH gives its recommendation and even if Ontario gives its recommendation, if hospitals have the resources they will set up their own HTA units. There's one at McGill. There's one in London, Ontario. The decision is always local, but the problem is that we don't have the resources for everyone to set up their own HTA.
CADTH is necessary and people want to add their own context.
4:45 p.m.
Conservative
The Chair Conservative Joy Smith
Thank you very much, Dr. Hoch.
I'm sorry, Dr. Sellah. The time is up.
We'll now go to Mr. Lobb.
4:45 p.m.
Conservative
Ben Lobb Conservative Huron—Bruce, ON
Thank you very much, Madam Chair.
At the root of the issue of innovation, or having somebody develop the next great idea, is that you've got this person who goes through elementary school and high school, a brilliant person who goes off to university, and let's say he or she goes off to the University of Waterloo and does four co-op terms. Then comes the decision, “What do I do?”
Nine times out of ten, the choice is to take the highest-paying job and go do it. They don't take the entrepreneurial approach of living like a university student for five more years to develop their brilliant ideas. That's part of the problem with what we're facing, not just here in Canada, but around the developed world. I'm quite certain of that.
So how do you turn the tide? Do you have to go back to the ministry of education provincially and try to re-establish the pride in entrepreneurship? What do you do with that? That isn't a silver bullet, but that's one of the pillars.
Yes, Mr. Holbrook.