Part 2: Exploring the potential for collaboration to trigger new initiatives and value-for-money in Canada’s healthcare system.

Part 2 of a two-part series on the benefits of public-private collaboration.

In part one of this series we focused on the arguments calling for collaboration between all levels of government together with private plan sponsors, insurers and healthcare providers. In part two we take a closer look at some collaborative initiatives in Canada and the U.K., as examples of the potential for increased efficiencies, innovation and cost-savings to Canada’s healthcare system.

Key to this debate is acknowledgement that sustainable results can only be achieved when public and private sectors stop protecting individual interests. Today, this behaviour often leads to cost shifting or, at its worst, no healthcare coverage being provided. What’s needed is for all stakeholders to start working synergistically, to common goals and measurements.

Today, all business models are tested on the global stage. Healthcare delivery is no different. We must look at best practices to raise the healthcare status of Canadians; to manage overall healthcare costs; and seek greater efficiency from the combined public and private expenditure. Productivity levels, competitive labour costs and, ultimately, the Canadian standard of living depends upon it.

It can be done.

MedsCheck extended to all Ontarians with OHIP coverage
Ontario’s MedsCheck program is a voluntary medication review service funded by the provincial government and provided by pharmacists to consult with patients on how to effectively manage their medications. It’s a positive example of how a government initiative can make overall healthcare improvements that benefit patients, and by so doing, creates efficiencies for both public and private health plans.

The result should be improved patient safety and treatment, better drug utilization, better health, fewer drug claims and overall cost reduction. This is a ‘win-win’ solution beneficial to all parties.

Quebec and wellness
In June 2007 the Quebec government passed Bill 1, An Act to Establish the Fund for the Promotion of a Healthy Lifestyle. Quebec will fund activities and programs that foster healthy eating, physical activity, and promote a healthy lifestyle. The fund is also intended to support innovation, and the acquisition and transfer of knowledge in these areas.

A collaborative approach would incite private initiatives of the same nature. For example, if the fund were to provide financial rewards to employers willing to sponsor similar wellness initiatives, a broader public-private sector solution could be achieved. Bill 1 provides an excellent opportunity for innovation and collaboration.

The U.K. way
In the 1990s, the United Kingdom committed to a reform focused on improving the quality of primary care, wait times, cancer care, heart disease and mental health. This change in focus required an unprecedented shift in resources and influence.

Its efforts reflect a strong willingness to think strategically, to experiment, to pursue change, and to reinvent the structure of its national healthcare system. It also reflects a determined focus on patient-centred care.

The U.K. set productivity targets for health outcomes and for health system performance. They looked to the private sector for solutions. They fostered synergy among all stakeholders including academic and research bodies, and policy makers.

While the ultimate test of the changes will only be revealed in the longer term, many of the U.K.’s actions, policies and best practices merit review for applicability in Canada.

Productivity improvements and measurements The U.K. set national performance targets with measurable goals and set time frames. Organizations are benchmarked and compared, identifying opportunities for improvement.

• “[In the U.K.] new policies, structures and approaches appear to evolve, in part, from the collaborative exchange of thoughts and ideas among government and a broad array of stakeholders.”
• “U.K. health reform is based on the premise that new spending must be accompanied by efforts to make performance and productivity gains.”
• “In Canada, there has been some resistance to benchmarking of health system performance in and among the provinces… We don’t systematically ask people if their lives have been improved by a health service… We don’t ask our governments if healthcare dollars have been well spent.”
• “While Canada has a rich and diverse public research sector, it lacks the synergy among academic, policy, practice and decision-making environments that is prevalent in the U.K.”
Source: Conference Board of Canada Report: The U.K. Way, Spending and Measuring in the National Health Service”, June 2007.

The government introduced policies to stimulate the performance of healthcare providers, as well as productivity and innovation. A national survey program regularly surveys patients about performance targets such as access and wait times. Accountability is key.

The U.K. established an independent commission responsible for monitoring and assessing the performance of public, voluntary and private organizations. It inspects both the quality and value-for-money of healthcare.

The premise is that money spent should be linked to health services and health outcomes.

Public-Private Synergy
Many of the U.K.’s new policies, structures and approaches had their genesis in the collaborative exchange among a broad array of stakeholders. For example, recent productivity research was the collective work of economists, academics and government.

To sum up
In Ontario, the Employer Committee on Health Care – Ontario(ECHCO)believes that employers share common objectives with government when it comes to healthcare. Private plan sponsors are key stakeholders, also working towards the goal of a healthier population and productive employees. Our challenge is to harness the best and brightest thinking from all parties in the Canadian healthcare industry.

We must recommit ourselves to patient-centredness. We must be willing to challenge traditional thinking, to work together with employer investment in healthcare and to try new, collaborative ways to improve our healthcare system.

For the first part of this series, click here.

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Sandra Pellegrini has left the panel because she has taken a year-long sabbatical. Brian Lindenberg will take her place on the panel.