Thank you.
I think many of the answers are there, and this is also why international comparisons can be so helpful, to look at how other countries actually organize the services, not just at how many positions they have or at how many nurses or how many physiotherapists, but at how they are actually organized and how they are financed.
I think one of the important questions to try to get at is how the way in which the money flows from a provincial government to hospitals and to health regions either encourages organizing in the way that is most effective for positive outcomes or does not. Does the way the money flows inhibit innovation in the way services get organized or does it not? Does it create barriers? This is going to be different in different places.
In health care, you can't escape getting down to this level of detail to understand where the actual levers for change are. Why is it that we have spent, from the federal level, $800 million over a number of years for primary health care transition, and yet when we look around and ask ourselves in which province primary health care has really been reorganized--and we know primary health care is crucial if we want to grapple with greater efficiencies down the road--it's very hard to do. What are the barriers? Why is it so hard?
The difficulty, I think, is that these things are linked together, but in order to have discussions, you have to pick them apart and say, “Aha. If we wanted to do things differently, then we would not want to be setting a whole bunch of rules for hospitals and how they spend their money. Maybe we would want to give them a block budget, or maybe their budget should be part of a health region.”
These things sound so arcane, and yet if you're looking for ways to change things and looking for ways to answer the question of why things don't get done, you have to get to that level of detail and then, in a sense, step into the shoes of the health minister from the province and ask whether you would really have wanted to take that on, because every time you make a change, it disrupts somebody's day out there. If you find it's less efficient to have an emergency department in a small hospital, you can guarantee that the minister's going to hear a lot about it if you do what might be a more efficient thing.
We all have to keep trying. We always have to keep working on these things. Not coming to grips with the fundamental political economy and the desire to keep on doing things the same way is preventing the actual implementation of research findings around organization of services that have been well known for years.