You might have missed it, but last Friday the Canadian government released the Report of the Advisory Panel on Healthcare Innovation, chaired by Dr. David Naylor. You might have missed it because the government did nothing to publicize the event. Reports from government panels may not be your favorite summer reading, but I strongly urge you to read this one.

The background of the report is the panel’s candid assessment of the state of Canadian healthcare: We’re pulling ahead of our OECD peers in what we pay for healthcare, while falling behind in terms of what healthcare providers deliver.

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What’s new in the report is several good ideas about why our healthcare system is falling behind and what should be done about it. Among these good ideas, the most prominent is that the federal government should create

a protected source of capital that dedicates funds toward innovation… to sustain momentum for change across jurisdictions. Accordingly, the Panel is recommending the creation of a multi-year Healthcare Innovation Fund… the Fund’s primary rationale is to support activities that lead to scalable improvements in healthcare, not to generate academic research.

The panelists noted that many jurisdictions had pioneered successful projects to improve healthcare. But the pioneers could not get beyond the pilot project stage, so that innovative programs could operate at a scale sufficient to affect real change. The Innovation fund would be patterned on the

the Center for Medicare and Medicaid Innovation [program] (CMMI) in the US [which] received an appropriation of US$10 billion under the Patient Protection and Affordable Care Act (2010) for 2011-2019.

The CMMI funded a series of large scale demonstration projects (I was part of this one). The most important projects have been the conversion of hospital systems into Accountable Care Organizations (ACOs). ACOs contract to provide care for defined populations. ACO contracts give healthcare providers incentives to hold down cost growth, but also to maintain or improve the quality of care. Most importantly, CMMI projects had to set targets for improvements in the cost and quality of care, and report on them.

But will any of this come to pass? As Wayne Kondro of iPolitics noted, the government is burying the report.

The blue-ribbon panel did not unveil its findings at a press conference and merely posted its findings on Health Canada’s website, late on a Friday and after the conclusion of a gathering of the nation’s premiers.

The inner workings of government
Keep track of who’s doing what to get federal policy made. In The Functionary.
The Functionary
Our newsletter about the public service. Nominated for a Digital Publishing Award.

And why might that be? Naylor and his co-authors wrote that in their charge from the government,

We were also told that our recommendations ”œmust not imply either an increase or a decrease in the overall level of federal funding for current initiatives supporting innovation in healthcare.” Although it was not an easy decision, we did not follow this guidance.

Clearly that was not appreciated in Ottawa. Kondro reports that

The report has been in the hands of the Prime Minister’s Office for the better part of a week and sources say PM Stephen Harper demanded revisions, which Naylor’s panel steadfastly refused to adopt, instead insisting on the report’s release, as written.

Kondro adds that

More broadly, the panel calls on the federal government to essentially end its intransigence and indifference on the health file.

Of course, the panel did not use those words. But they have a point. The federal government’s hands off policy toward Canadian healthcare hasn’t worked. The provinces and Ottawa have to find new ways to work together.

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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