Building a Sustainable Health Care System

By Naylor, David | Canadian Speeches, June 1997 | Go to article overview

Building a Sustainable Health Care System


Naylor, David, Canadian Speeches


Maintaining quality, accessibility and affordability in Ontario's $17 billion health care system demands reforms to secure the best possible returns from every dollar spent. Greater private spending is dismissed as either a tax on the sick, a prescription for social divisiveness, or a major additional burden on the payrolls of Canadian businesses. A modest increase in public spending is called for, but the amount must be limited by other competing social demands which could yield even greater returns in health and well being. A roll-back of planned further across-the-board cuts in funds for hospitals is called for, and specific reforms are proposed. Speech to the Canadian Club of Toronto, April 28.

The previous Government of Ontario had the unhappy task of putting the brakes on an accelerating $17 billion-a-year health care locomotive. The current government and its successors have the equally unenviable task of trying to retool the train while it rolls down the track carrying an ever-larger load of older and sicker passengers.

In this afternoon's talk, I shall start with some reflections on health care expenditures. I shall then touch on some aspects of how we currently fund and organize in Ontario, highlighting potential obstacles to the creation of a more sustainable health care system. I shall briefly touch on short-term restructuring and budgetary issues; and then turn finally to some ideas for the longer-term reconfiguration of health care.

The aim of our health care system remains the provision of effective care to all those in need, at a cost and in a manner that is acceptable to the individual patient, those who work in the system, and to society at large. This is no easy matter.

The "impossible triad" in industry is said to be: good, fast, and cheap. The smart CEO tells her customers that they can have any two without compromise. In health care, our "impossible triad" is accessibility, quality, and affordability. Affordability is obviously constrained in Ontario as elsewhere in Canada. Thus, erosion of quality or access is the logical concern.

Given that concern, I am sometimes asked whether we should be spending more on health care. Some advocate more private money. However, we already raise and spend about 28 cents of every dollar outside the public system in Ontario, more than most European nations, and double the level in the United Kingdom, which actually has a parallel private system. It's accordingly hard for me to imagine how more private spending would be anything other than a tax on the sick, or a prescription for social divisiveness, or a major additional burden on the payrolls of Canadian businesses.

And so the real question becomes: what will the marginal returns of extra public expenditure be?

As a physician practicing in a teaching hospital, I do see individuals for whom health services provide dramatic benefits. I share my colleagues' frustration with waiting lists and bed pressures. And the research literature certainly supports the notion that medical progress has a lot to offer today's patient.

But let us also be realistic about modern medicine. Despite some wonderful advances, and despite the promise of molecular and genetic engineering, there are still no magic bullets to eliminate coronary heart disease, most cancers, osteoarthrisits, Alzheimer dementia, and a host of other disorders.

Thus, extra public expenditure on health care may draw resources away from other programs that could effect greater improvements in health and well-being across the whole of society.

I think here specifically of the effects of social deprivation on children, or the need for vibrant and well-funded schools and universities, or the growing problem of labor market adjustment and retraining in an era when transient joblessness seems likely to afflict more and more Canadians. These areas arguably need more support than they have been getting, and they are very legitimate competitors with the public health care budget. …

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