Why Ontario's health-care system is allergic to efficiency

Toronto Sun ^ | 2010-03-21 | John Snobelen

Posted on Sunday, March 21, 2010 10:08:03 AM by Clive

If you throw a stick for your dog and he just sits there looking at you, it doesn’t mean much. But if you keep throwing that stick for 10 years and the dog still just looks at you, there might be a message. The dog doesn’t want to play stick.

That sort of profound conclusion is missing from the health care debate.

Fifteen years ago Premier Mike Harris came to office determined to get a smart card for health. One card that contained all of a person’s health records and information. It was a great idea.

Harris also wanted patients to get, and sign for, an invoice for the health services they had received. That seemed like a pretty common sense way to make sure that people actually received the services OHIP got billed for.

It also seemed sensible for people to know exactly how much their health care cost.

Harris was not famous for giving up on good ideas, but when he left office eight years later there was no smart card and no patient invoice.

When Dalton McGuinty entered the premier’s office five years ago he wanted eHealth, electronic records that could follow a patient, reducing administrative costs and making the system safer for patients. Sounds like a good idea to me.

Five years and a billion dollars later the health system is still an information technology wasteland.

There might be a message here. Maybe, just maybe, the health care system doesn’t want to be more efficient.

That’s not to say that docs and nurses don’t want to be freed from mountains of paperwork or that hospital administrators don’t want to ... well, administer, but the incentives in the system don’t call for change.

Who pays for redundant tests or misdiagnosis? Who pays for an paramedic team to wait, sometimes for hours, for a patient to be admitted to emergency? Who pays for lost records? Who pays for improper or fraudulent billing?

You do. And until someone in health care has some skin in the cost side of the business, being more efficient and effective will be a nice thought, not a necessity.

Know the costs

If we want affordable health care we are going to have to get the people who pay for it, that would be you and I, to have a little more interest in the costs. That sounds like real public ownership to me.

But our version of public health care does not embrace you as a decision maker. Our system was designed to treat, not inform, you. You don’t need to know what a procedure costs or what the alternatives are. You don’t need to know what an aspirin dispensed in an emergency room costs. You don’t need to know much; in fact the less you know the smoother the system runs.

There are lots of ways to put people into a position of power in the health system. Some form of deductible is one of the most common suggestions. But every patient empowering initiative has been resisted by the medical community.

Every time a fundamental change to the health care system is suggested the same old tired arguments are dusted off and trotted out. But the truth is we are out of money and the cost of care has to come down. Spending 46¢ of every provincial dollar on health care is too much — and that number is expected to rise to 70¢ within 12 years if nothing is done.

Some dogs won’t chase sticks and the health care system won’t lower costs. That means you and I are going to have to be more involved or the government will continue to make health care choices for us. And, trust me here, that dog won’t hunt.