Improving the quality of the healthcare system shouldn't be so hard, former minister says

TORONTO – In February, a group of academics at U of T held a day-long event examining healthcare leadership and policy issues. Called FHLIP, short for the Future of Health Leadership, Informatics and Policy, the session was organized by Dr. Karim Keshavjee and Dr. Abbas Zavar. Both teach in the university’s health informatics program.

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To kick off the day, ‘recovering’ Ontario health minister Deb Matthews, PhD, gave an entertaining – and illuminating – address on why Canada’s healthcare system doesn’t perform so well.

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“It should be much better than it is,” she began. Matthews cited the New York-based Commonwealth Fund’s studies on international health systems.

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“We’re better than the U.S., but the U.S. is number 11 out of 11 countries. Canada is number 10.”

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She explained that it’s not about the money, as Canada spends more or equal amounts per capita compared with nations like the UK and France. Rather, it’s about creating systems that produce more bang for the buck.

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Indeed, she noted the UK is number one in most of the rankings; if we want to improve, we should emulate what they are doing, instead of watching our neighbors to the south so closely.

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The Commonwealth Fund measures factors like universal medical coverage, including pharmacare; access to care; and things closely related to health, such as social services and homelessness.

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Canada doesn’t score high in these areas, but she did mention one bright light: outcomes, including cancer care results.

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Matthews warned that things are likely to get worse, with the arrival of the ‘grey tsunami’, the aging Baby Boomers [the post-war generation born between 1946 and 1964.] “People don’t understand demographics,” she said. “As [demographer] David Foot said, demography explains two-thirds of everything. And we are very ill-prepared for this demographic challenge.”

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The current system is designed for episodic care, not chronic care – which would benefit the aging Boomers. In the past, people have often relied upon family for care. But as Matthews put it, “My mom had six kids, I have three, and they will have less.” There are going to be fewer family doors to turn to.

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The social determinants of health, she said, “are grossly undervalued. But poverty, homelessness and illiteracy is expensive.”

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Why can’t we give everyone a warm place to stay and enough to eat? Matthews observed that putting someone in a hospital bed costs roughly $1,000 a day, a jail cell costs $500 a day, a shelter bed costs $300 per day, and supportive housing is $100 per day.

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“Knowing that, where should we put our money?” she asked. “Seems we should put it into supportive housing.”

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Well, why not just change the system and fix it? Matthews asserted, “Never underestimate the power of inertia. Healthcare is highly resistant to change.” She noted that when Medicare was introduced in Canada, doctors fought the upcoming legislation, even though they would still get paid.

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On the systemic level, she said, “Government budgeting sucks.” The government does a poor job of tracking performance of various programs. “We need to do a better job. We need to stop funding programs that don’t work, so we can fund those that do.”

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Matthews explained that government officials go through new programs line by line, but if you have a great idea to save money, only the costs are included in the analysis – not the savings. “That’s why it’s been so hard to deal with homelessness. We know how to do it.” But initially, it will cost more money than it will save.

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One solution that seems to work, Matthews said, is shedding more light on the internal workings of hospitals and clinics. She cited the case of posting surgical wait times, showing for example, where you could get a hip replacement the fastest.

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The public could clearly see that if the wait was six months in London, Ont., and six weeks in nearby Owen Sound, it was better to go to Owen Sound for the procedure. “Sunshine successfully shortened wait times,” said Matthews.

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While railing against policy and programs, Matthews did have glowing things to say about people working in the system. “People working in healthcare are dedicated to patients. During Covid, they masked up and gowned up and risked their lives. They kept us alive.”