Thank you.
I'd like to take the first couple of minutes to introduce myself. I'm a faculty member at the Centre for Health Services and Policy Research at the University of British Columbia in Vancouver, where my specialty lies in evaluating the organization, delivery, and funding of health care systems. I'm a Scholar of the Michael Smith Foundation for Health Research and I'm also Canada's Harkness Fellow in health policy.
I'm currently studying the health reforms that President Obama has enacted in the United States in Medicare. I'm working in Washington, D.C., as a foreign scholar for the next 10 months.
I welcome your questions in both English and French.
The international results are in. Canada again ranks last in the ranking of the top 11 industrialized countries in terms of access to many kinds of hospital-based care and specialized care, with substantial waits for hospital care and to see a specialist. I think the persistence of these trends is demonstrating that we are clearly performing very poorly on some aspects of the health care delivery system.
Recent data also shows that Canadian governments are spending over $60 billion a year on health care in the provinces, with another $30 billion each on drugs and physician care, based on 2012 statistics provided by the Canadian Institute for Health Information. Where does this put us internationally? We're definitely in the top percentile for spending per capita among nations. This draws a really harsh light on the paradox between our very poor access to specialized care and our very high expenditures.
Given these findings and the persistence of these findings, we should be paying much more attention to how we spend these massive amounts on health care. The way we pay for our health care provides incentives for providers of health care to act in certain ways and engage in certain behaviours. For example, global budgets, which are the way that we fund most health care providers, reward cost minimization and rationing of health care.
What are the results of the behaviours that we're currently paying for? There are many examples of inefficiencies, ineffective care, and unsafe practices in health care. Two significant ones certainly spring first to mind.
First, from time of referral, the time to see a specialist often exceeds more than 12 months. In other words, from the referral from your general practitioner to a surgical consultation, the median time exceeds a year. That's a long time if you're in agony, or your quality of life is suffering, or you're debilitated.
Second, this is very shocking but is not news to many of you who work in the health care industry: every single day there are thousands of patients who are in hospital beds and are ready to be discharged safely, but there's no place for them to go. They even have a name for them: “alternative level of care”. It's a very prevalent problem in our Canadian hospitals. This use of hospital beds is inefficient and unsafe for patients and has detrimental effects on the hospital staff who care for them. It's also associated with the clogging of our emergency departments, something I've written about extensively.
We should, I believe, expect more from our health care system and strive for a high-performing health care system on cost efficiency, access, higher quality, and safe care. In my forthcoming report on the use of funding methods to change the delivery of care, I advocate using policies that have been proven effective in other countries in improving access, especially to surgical care. I also advocate that we curtail policies that ration resources and restrict access to care and lengthen wait-lists.
To do so, we should create incentives for the health care system as to what we think we want from it. For example, if our policy imperative is to improve access, then we should use a funding mechanism that rewards access to hospital-based care. This is known as activity-based funding and is the predominant form for funding hospitals across the industrialized world. There are also many strategies that other countries have developed for mitigating the risks of rising expenditures from these kinds of methods.
Similarly, we can develop, design, and implement incentives for community care providers to pull waiting patients from the hospitals when it is safe to do so; I refer back to my comment that every day in hospitals there are thousands of patients who are waiting to go home. By doing so, we'll improve our access to hospital-based care for those thousands of patients waiting for their elective surgeries and hopefully improve the clogging of our emergency departments.
Now I want to highlight the two provinces that are trying to figure out how to use these innovations to try to achieve their policy aims of improving access.
First off, British Columbia is starting implementation and experimentation with activity-based funding for elective procedures, as a small proportion of overall hospital funding, to increase the volume of elective surgery and improve access and decrease wait-lists. An evaluation is ongoing of the effectiveness of these policies, but they're widely implemented in many other countries.
On the other hand, Ontario is using a new policy initiative for certain chronic conditions, tying funding to best practices of care. That is, they are funding, they are creating incentives, to reward providers to provide the evidence-based care that patients with those conditions have. This is known as QBP, for quality-based procedures.
A third example originates in the United States. I'm currently studying it. It employs innovative strategies for addressing the seams between the silos in the delivery systems. That might be between post-acute-care providers or between the hospital and home. Known as bundled payments, the incentives are based on reducing avoidable or unnecessary care. Research has demonstrated its feasibility in some Canadian provinces already.
So what's missing from these policies in order to execute innovations to address the limitations in our current health care system? Well, much work needs to be done. Our national health information agency has to adapt and provide the plumbing for these innovations to be successful. I think this is an achievable goal in the short term.
In the medium term, I believe one agency should also specialize in identifying innovative and successful health delivery strategies that work in regions or in provinces and in disseminating that information elsewhere. Currently there's not a clearing house for good ideas, and I think that would be a useful role to be played in the medium term.
In the long term, I believe there's a very prominent role to be played by collecting patient-reported outcomes and patient-reported experience measures so that we can tie patients' experiences and their outcomes with how to direct care and resources to those who need it the most, and waiting patients.
With that, I conclude. I'd like to thank the committee for the opportunity to present my views on the state of innovation in the health care system in Canada.