The problem with Healthcare is not just Healthcare’s problem

In the 1996 book “The Pig and the Python” the authors speculated on how to take advantage of the baby boom generation to shape financial investment strategies. While a disturbing mental image, the same analogy can be drawn to the impending challenges to our healthcare system.

Currently our healthcare system is focused on the 1, 5 or 20% that are driving the majority of healthcare costs. Rightfully so!
But what about the bubble that is behind that, the so-called pig, or baby boomers….. Who is looking after the trailing 5% that will become the future 1%, or the 20% that will become the future 5%? And by-the-way those %s will represent a lot more people.

I contest we need to start looking outside the healthcare system and more formally engage other groups to work on this problem. While we have myriad problems with the healthcare system in our country, perhaps we need to look outside the system for some of the more strategic solutions.

So what do I mean by that? Health is a societal responsibility, not just a healthcare responsibility. Yes the healthcare system can be improved. It can make more efficient use of its resources. Can it improve how care is delivered, yes. Can it do a better job of preventing disease, sure. And so on. All this is true. Also true is that if we do not address the issue of sustainability and affordability, greater than 60% of the public spend will be going to healthcare in 10 or so years.

Our formal healthcare system can and should focus on the sick. Hence the inclusion of the word “care” in healthcare. So where else does responsibility for health (not healthcare) lie?

I think there are four stakeholders groups that can be engaged more in matters of individual and collective health: employers, insurers, government, and Canadians themselves.

In the category of learning from others, let’s look at the US healthcare system for a moment. Major changes have been driven by employers. It started with the 1999 landmark IOM report on patient safety and electronic medical records. The result of this was a major push by employers to have EMRs implemented in hospitals. Why? Because the employers were bearing the brunt of healthcare costs and implementing EMRs would save them money.

How can we parlay that into our healthcare system? Employers have a huge financial incentive to keep their workers healthy and productive. While perhaps not as impactful as in the US, insurance costs can be lower. More importantly lost work days can be reduced and productivity improved. That goes to the bottom-line.

Major corporations are also adept at bring innovation, discipline and an investment mindset to challenges and opportunities. On a related note, for another article, they are more skilled in the use of data to analyze problems, trends and make decisions. This we can certainly learn from for the healthcare system.

Let’s look at government’s role, and again the US look at the impact Meaningful Use and more recently the Affordable Care Act has had. Here government has implemented policies around reimbursement that have caused the healthcare system to react dramatically and quickly.
In Canada, what if the federal government offered tax incentives for employers to keep their workforce healthy? This is not dissimilar to the tax breaks Canadian parents get for enrolling their kids in activity programmes.

Now look at insurers. Here the incentives are quite obvious. A healthier workforce is a more profitable business. Enough said.
And lastly, but not least, Canadians. We all hear two things:

  1. We need to take more responsibility for the health of ourselves and our families; and
  2. We should not be expected to pay for anything related to healthcare.

The latter btw is not true, but let’s go with it as a broad-brush statement. What if we had financial incentives whether at work or on our tax returns for healthy behaviour? Would that cause us to act? Maybe. However sad, I submit this is more likely than the intellectual drive for a healthier life.

In summary healthcare is a societal problem, one where several stakeholders must take an active, perhaps leadership role in addressing. I am hoping this may stimulate a broad dialogue on how to mobilise other segments of our society to take action.

Of note, this line of thinking was a core theme of a recent CHIEF event in Halifax. Expect to hear more from that group.

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