The problem with discussing health care sustainability is there is no definition of what that means. Data would suggest that our health care spending is not out of control – the so-called cost curve has already been bent. Past increases appear to have occurred in sync with economic growth, the exception being the economic crash of 2008. Clearly those who are worried about sustainability are not equating it with affordability.
Across Canada the average increase in provincial health care spending this year is 2 per cent – hardly a matter of excess especially when one considers aging and population growth.
While Canada has done better than just about every other country in the OECD in controlling health costs, it has often come at a difference kind of price given quality issues that persist.
This week the Conference Board of Canada is hosting a two-day conference in Toronto on health care sustainability. Next week the discussions will be sure to spill over into the Ontario Hospital Association’s annual get-together at HealthAchieve. We’ll be at both.
Earlier this year health policy analyst Steven Lewis and former Cancer Care Ontario CEO Dr. Terrence Sullivan issued a paper on how to keep the cost curve bent.
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UBC’s Michael Law with Saskatchewan health policy analyst Steven Lewis.
VANCOUVER – Canada’s Medicare system stops the minute a doctor writes a prescription.
On the second day of Pharmacare 2020, the talk turned to how we get to a quality system that will leave no Canadian behind, that will be efficient, accountable, and evidence-based.
Saskatoon health policy analyst Steven Lewis says leaving drug coverage out at the dawn of Medicare was an accident of history. If we were to create a pharmacare program from scratch, the task would be much easier. The problem is how do we transition from the house we built for ourselves to the one we want to live in?
Another audience participant astutely remarked that from the 30,000 foot level there is a great degree of consensus, but getting closer to the ground is going to be more difficult.
Lewis is blunt about the reasons why – a public pharmacare system would create winners and losers. Doctors would be the winners – a public pharmacare system would better mirror their existing practices. It would be more difficult for retail pharmacists who may need to define what their role is within the health system. Should they be remunerated as the owners or employees of a retail outlet, or should they join the mainstream of health professions and get remunerated based on the service they render to the public?
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It seems there are two choices with regards to executive compensation.
The first is to simply place executives on salary and expect them to do the job they get paid for. That’s how rank and file employees get paid.
The second is to divide compensation, setting out a certain amount as “base” salary, the rest as bonus based on established performance benchmarks.
The Local Health Integration Networks can also claw back a percentage of a hospital CEOs salary if the hospital fails to live up to the terms of its accountability agreement with the LHIN – not that we are aware of this ever taking place.
The LHINs themselves may be a bit gun-shy about using these powers given they themselves are struggling to meet their own performance targets. The Erie-St. Clair LHIN, for example, missed 11 of 14 performance targets for 2010-11.
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Saskatoon health policy consultant Steven Lewis agrees with NDP leader Andrea Horwath that there needs to be a cap on Ontario hospital CEO salaries.
While calling the issue mostly symbolic – he says the income of hospital CEOs barely covers Frank Stonach’s tip money – Lewis asserts that most CEOs are not motivated by the pay rate. Nor is there any evidence that CEOs are leaving for megabucks jobs in the private sector. Given hospital CEOs make far more than their counterparts in the public service, why shouldn’t there be a reasonable cap?
To read Lewis’ essay on the Longwood’s site, click here.