Monday, April 03, 2000
National Post (Financial Post)
What we don’t know about health care
Lack of information on waiting times, outcomes prevents effective action
By Brian Lee Crowley and David Zitner
If your teenager asked for a bigger allowance, you’d ask what he did with the money you’d already given him. Isn’t that the question we should ask politicians and hospital administrators when they clamour for more? And do we really want to know how many thousands of patients received treatment, instead of how many became healthier through the money already spent? And how long those people had to wait before receiving needed treatment? Today, no one can answer these questions.
Yes, the health-care system collects a lot of data. But most of it is next to useless in answering these key questions. Many mistakenly believe that organizations such as StatsCan or the Fraser Institute provide meaningful waiting time information. StatsCan, through the Canadian Institute for Health Information (CIHI), collects information about length of hospital stay, but not waiting times or effectiveness of care. The Fraser Institute annually surveys doctors’ opinions about waiting times. But since doctors themselves do not systematically collect this information, the survey results, while important, are only impressionistic.
This dearth of information is consistent with a system that doesn’t pay doctors, administrators, nurses and other health-care workers for concrete results. Instead, money flows on the basis of political negotiation and political expediency. Money doesn’t flow to maintain proper waiting times because no community has regular and reliable measures of how long people wait, data needed to inform us about the pain and physical deterioration they have had to endure before they even got the system’s attention. But we don’t know that, and there are no plans to get it.
Health-care officials can tell you how many people were treated for cancer, whether they stayed in the hospital the prescribed number of days, and no more. That is the system’s measure of success. If the patient dies the day after being released, health administrators won’t know and hospital records won’t be amended.
Because patients have no recourse for inadequate care, the system doesn’t need to collect such information. As an effective monopoly provider of most health care, our medicare system — unlike other parts of the economy — can afford to remain ignorant about its performance.
As long ago as 1994, the country’s deputy ministers of health commissioned a working group to reduce the cost and increase the effectiveness of care. Its report, “When Less is Better: Using Canada’s Hospitals Efficiently,” was unanimously endorsed by each deputy minister. Yet the need for guaranteed “timely access to services either in the hospital or the community” and for “information about waiting times [to be] made public,” among other important recommendations, have been ignored. It is now 2000.
Out of the $60-billion or so annual allowance we give our public health-care system, $95-million is earmarked for CIHI. Yet CIHI persists in asking more of the wrong kinds of questions, forcing hospitals to spend more of their scarce resources to answer them — around $1-million for the average 500-bed acute care hospital.
Take the single question of measuring access to health care. Under this heading, CIHI proposes to measure influenza immunizations, mammography in women aged 50-69 and pap smears for ages 18-69. But not how long people have to wait for care. Not only do these questions not address the single most important thing we need to know about access, some are peculiar in themselves. The rate of pap smears in the population as a whole, for example, is less important than the appropriateness of who gets this test. The people most at risk of carcinoma of the cervix — detected by pap smear — are those who have early sexual relations, multiple partners and unprotected sex. The frequency of cervical cancer in people with few partners or who start intercourse at an older age is quite low. The questions proposed to measure the effectiveness of our health-care system are similarly uninformative about how many people actually got better as a result of the system.
In spite of spending $60-billion a year, the ministers of health cannot tell us how long we have to wait for various procedures, or to see specialists, or even GPs. They can’t tell us whether the health-care system makes us healthier or sicker, or neither. And there are no plans to make this information available next year, or the following year or the year after that.
Now, tell us again why you think you deserve more money.
Brian Lee Crowley is president of the Atlantic Institute for Market Studies
David Zitner is director of medical informatics at Dalhousie University