Through Canadian and international perspectives, Bending the Cost Curve in Health Care explores the management of growing health costs in an extraordinarily complex arena. The book moves beyond previous debates, agreeing that while efficiencies and better value for money may yet be found, more fundamental reforms to the management and delivery of health services are essential prerequisites to bending the cost curve in the long run. While there is considerable controversy over direction and details of change, there also remains the challenge of getting agreement on the values or principles that would guide the reshaping of the policies, the structures, and the regulatory environment of health care in Canada. Leading experts from around the world representing a range of disciplines and professional backgrounds come together to organize and define the problems faced by policy-makers. Case studies from the United States, the United Kingdom, Australia, the Nordic countries, and industrialized Asian countries such as Taiwan offer useful reform experiences for provincial governments in Canada. Finally, common Canadian cost factors, such as pharmaceuticals and technology, and paying the health workforce, are explored. This book is the first volume in The Johnson-Shoyama Series on Public Policy, published by the University of Toronto Press in association with the Johnson-Shoyama Graduate School of Public Policy, an interdisciplinary centre for research, teaching, and executive training with campuses at the Universities of Regina and Saskatchewan.
Through Canadian and international perspectives, Bending the Cost Curve in Health Care explores the management of growing health costs in an extraordinarily complex arena.
Canadian provinces typically devote approximately 7.7 per cent of their GDP to health expenditures?a figure that some say could climb to around 10 per cent by 2030. However, we are not doing enough to prepare ourselves for the type of high acuity and cognitively impaired patients who will soon need long-term care, and which require different set of investments, capital stock, and health human resources than we currently deploy. Currently, expenditure growth on public health care appears to be slowing, though it is unclear whether this slowdown is the result of the provinces' success in sustainably bending the cost curve, or a result of short-term cost-cutting in response to reduced economic growth and federal health transfers. So where can we start? And what can be done to address this issue before it becomes a major crisis? Free Book for all Participants! Each registration includes a complimentary copy of Dr. Marchildon's book, "Bending the Cost Curve in Health Care: Canada's Provinces in International Perspective".
The need to prioritize efforts to improve the health of the Canadian population to promote the fiscal sustainability of Medicare dates back to at least the Lalonde report (1974), and was proposed in the Kirby commission (2002) and the Romanow commission (2002): M. Lalonde, A new perspective on the health of Canadians. [...] L. Kirby, The Health of Canadians - The Federal Role: Final Report on the State of the Health Care System in Canada (Ottawa: Senate, Standing Committee on Social Affairs, Science and Technology, 2002); R. J. Romanow, Building on Values: The Future of Health Care in Canada: Final Report of the Commission on the Future of Health Care in Canada (Ottawa: Queen's Printer, 2002). [...] The value of the health care costs avoided in the immediate term would be augmented by future health care costs avoided through the prevention of chronic diseases.7 Assessing the effectiveness of the program for preventing chronic diseases is the focus of ongoing work. [...] For program participants in the first year of the program, there are statistically significant reductions of 25 per cent in the number of hospital visits and of 17 per cent in the number of emergency department visits, relative to what we observe in the age- and sex-matched controls. [...] This trend in per participant costs of the program is attributed to changes in the content and delivery of the program reflecting the experience gained through eight years of operating combined with the results of internal program evaluation and external research on the program.
Ideas and Opportunities for Bending the Health Care Cost Curve Advice for the Government of Ontario April 2010 Together, we represent a group of provider associations committed to building a better health system: • The Ontario Association of Community Care Access Centres (OACCAC); • The Ontario Federation of Community Mental Health and Addiction Programs (OFCMHAP) and; • The Ontario Hospital Assoc [...] As evidenced by the Wait Times Initiative and other systemic Transformation projects, government clearly recognizes the importance of holding a vision of the system for the short, medium and longer-term, and of considering cross-sectoral impacts. [...] Specifically, on an annual basis: • 1% of the population accounts for 49% of combined hospital and home care costs; • 5% of the population accounts for 84% of combined hospital and home care costs.2 The HBAM dataset can be drilled down to very specific service types and patient groupings to identify opportunities to improve quality and cost in targeted areas. [...] In addition, the Ministry's Framework document cites examples of the cost impact of chronic disease and the economic benefits of specific strategies in various jurisdictions. [...] A high level estimate of the potential for the province, based on what is currently known about ALC populations, provides an order of magnitude of the possibilities for shifting care out of the hospital, into the home, with appropriate supports and resources.
"Provincial government health spending has entered a new era of restraint ? the second such era in Canada?s history. However, it is not clear that publicly funded health systems have achieved lasting efficiency gains by ?bending the healthcare cost curve.? After all, we have seen a similar narrative before: in the mid-1990s, there were four years of declining per person health spending that were followed by a lengthy period of rapid growth. Are we likely to see a repeat of the past ? in other words, are we witnessing a temporary pause on the upward trajectory of health spending ? or have permanent, lasting changes to health spending growth taken root? This Commentary compares the two major periods of restraint in Canadian healthcare spending and finds that, after controlling for broader economic and fiscal variables ? such as provincial GDP and federal transfers ? as well as physician supply growth and population aging, there is no clear evidence that a lasting period of health spending restraint is underway. There are a number of reasons to speculate that the current period of cost restraint may be temporary, such as the inability of provinces to maintain relatively large decreases in capital spending, rising cost pressures from ?nichebusting? drugs, and the large number of medical school graduates being assimilated into the health system each year. However, there are policies that could strengthen provincial government efforts to achieve effective cost restraint in healthcare and put publicly financed healthcare on a more sustainable footing. For starters, the federal government should, in discussions with the provinces over a new health accord, not yield to provincial demands for more money. Since 2004, the Canada Health Transfer has been growing at 6 percent per year ? nearly doubling in overall size over the last decade ? and is currently scheduled to grow at a slower pace starting in 2017. Given evidence that federal transfers can be a key driver of provincial health spending, a return to something near a 6 percent escalator ? the same size as in the 2004 health accord ? would likely spark an increase in provincial health spending and forestall efforts to bend the cost curve. The federal government should instead stick to the formula set by the previous government that would see provincial health transfers grow with the Canadian economy and never fall below 3 percent annually. When originally announced in 2011, the prospects for economic growth were robust and a 3 percent floor seemed unlikely to come into effect. With much more subdued prospects for economic growth in 2016 and going forward, guaranteeing that the health transfer grow by no less than 3 percent annually should be considered generous. Efforts to control health costs will always be subject to criticism. In particular, the sharpest concerns will come from groups whose incomes may be squeezed by government efforts. Without data on patient outcomes, however, governments cannot demonstrate that patients are unaffected by cost-control efforts and that quality of care is maintained ? this makes governments particularly vulnerable to claims that patient care is being eroded by budget cuts. Better data keeping should help create an environment that would allow governments to achieve lasting improvements in financing healthcare while maintaining, or improving, care quality."--Page [1].
Despite notable variation in health care policy from province to province, most scholarship published on the health care system in Canada uses a broad national perspective. Focusing on the health care systems of individual Canadian provinces and territories, our new series, Health System Profiles, examines the social, political, economic, and epidemiological context of health care policy in each Canadian province. Turning a critical eye to the health care system in Nova Scotia, author Katherine Fierlbeck outlines the organizational and regulatory frameworks structuring provincial health care, while providing a detailed assessment of Nova Scotia’s health financing, physical infrastructure, service provision, and the efficacy of technological resources used in data tracking and health quality assessments. Structured for ease of comparison, Nova Scotia: A Health System Profile will, along with other volumes in the series, help scholars draw analytic evidence-based policy conclusions about the health system of Nova Scotia and other Canadian provinces and territories.
