Rachel Aiello published an interview with Health Minister Rona Ambrose yesterday in the Hill Times (paywall). Aiello asked what was the single biggest challenge facing Canadian health care today and the Minister replied:

The need for innovation is one of the most pressing public policy challenges of our time. We are in a new world, in economic and fiscal terms, and health-care systems need to adapt. Governments can no longer afford to throw money at the problem as they did in the previous years. Instead, we need to work with the provinces, territories, and stakeholders to achieve better value for money, so that our collective investment in health care produces the best possible health outcomes.

I agree completely. We need to reform a frozen Canadian health care system so that it makes rapid progress on improving population health outcomes, the patient experience of care, and the equity in health outcomes. Moreover, we cannot expect a significant increase in spending, so we have to achieve higher value for our health care dollars, delivering services more efficiently and getting greater productivity out of the health care workforce.

Some people argue that focusing on efficiency in health care devalues human life. It might, if one forgot that health care is governed by many values — including justice, autonomy, and caring — and not just efficiency. But we also need to see that a dollar spent on health care is a dollar that was not spent on education, on housing, on child protection, on policing, or any other public enterprise that advances human well being. We need to worry about how well we are spending our health dollars because they have an opportunity cost that reflects the myriad other things we need.

So if a government takes the value of health care seriously, what should it do? In the interview, Ambrose described some initiatives of interest to the government, mostly having to do with the health of the elderly. These initiatives have merit, but I think she missed a larger point.

If we are serious about improving the value we get for a health care dollar, the first order of business is accurate measurement of health outcomes and health care quality. Without accurate and detailed benchmarks of national health, we can’t give credible answers to the question of whether our health policies are working.

The government has, however, reduced both the quality and quantity of health data. Statistics Canada has lost significant funding. The National Population Health Survey has been ended. The Health Council of Canada is now defunct.

There is no reason why we should endlessly repeat the administration of the same health surveys. But they were better than nothing. A health policy that took the value of health care seriously would include significant new funding for Statistics Canada and the Canadian Institute for Health Information. Are you worried that “health” and “health care quality” are difficult to measure accurately? I am too! So let’s commit resources to the Canadian Institutes of Health Research to develop innovative ways to do it better.

I’m entirely on board with the spirit of the Minister’s remarks. But in practice, taking health care value seriously means measuring it. Otherwise you’re just handwaving.

William Gardner
William Gardner is a child psychologist at the Children's Hospital of Eastern Ontario and Professor of Epidemiology at the University of Ottawa. He writes professionally on children's mental health, on statistical methods in social research, on Canadian and US health policy, and on ethics. He also blogs at The Incidental Economist. @Bill_Gardner

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