In Canada, health care costs the public sector about $ 160 billion a year, a higher per capita cost than most industrialized countries. Yet Canadians are not particularly healthy and do not receive better care.

The Commonwealth Fund has ranked Canada tenth among eleven developed countries for the efficiency of its health system (only the United States is worse than us). We are at the bottom of the list with respect to access to care, speed of care and overall quality of care, and for none of the measures reviewed we ranked in the top three .

Maybe our health system is not as good as we like to believe. How can we improve Canadian health care to catch up with the pack?

One factor that works against us is how public health spending is distributed. For example, the way we spend money on health is often process-driven rather than results-based. Most provincial governments pay health care providers on a fee-for-service basis, at least in part, rather than on health outcomes. Doctors are often paid , at least in part, by the number of patients they see or the actions they take without much regard to the quality or appropriateness of the care provided.

A system that promotes improved quality and access to care, offers the best possible return on health budgets, and rewards innovation may be the answer.

The goals sought by patients, a good care experience and a sustainable quality of life, could be measures of success. Financial incentives that reward healthcare providers for maintaining good health for their patients would encourage innovation in important areas of health that historically have been difficult to implement, such as health promotion and management. prevention of the disease.

How could we achieve this?

Governments can not impose innovation, but they have some leverage to encourage those who want to experiment and innovate. Establishing an innovative national vision to drive change would send a powerful signal that the status quo is not in the best interest of Canadians.

Governments can not impose innovation, but they have some leverage to encourage those who want to experiment and innovate.

Interesting financial experiments have already been conducted in Canada.

In Mississauga, hospital care providers Trillium Health Partners and Saint Elizabeth home care have agreed to be jointly paid by the province based on the health status of patients with heart disease as they leave the hospital. Linking their funding has encouraged both organizations to work more closely together and to ensure that patients experience a seamless transition between care while reducing associated costs. After one year, the results are promising. Patients are discharged earlier and postoperative readmissions to hospitals and emergency departments are declining.

New Brunswick is implementing new approaches to provide better health care to the community. Medavie Health Services, a private provider of medical and emergency health care services, will soon enter into a performance-based contract with the province. The reimbursement will be related to measures related to increasing the system capacity and improving the patient experience and health outcomes of the population.

Meanwhile, the federal government recently unveiled the first social impact bond to promote health in Canada by supporting a blood pressure control program led by the Heart and Stroke Foundation, in collaboration with the Canadian Stroke Foundation. MaRS Impact Investment Center. The payments the Federal Heart and Stroke Foundation will receive will vary in terms of controlling participants’ blood pressure.

These experiences are important first steps, but the ambition must be much greater in order to be able to make a real change.

Canada needs a national strategy for measuring results and health financing, in partnership with the provinces and territories, and a great willingness to test new approaches and adopt those that work. Federal support and evidence-gathering unit could provide expertise in funding innovation for provinces and health care providers seeking to test new payment approaches and allow others to learn from those who have already done so in Canada and abroad.

We need to change our focus to achieve better health outcomes and better returns on spending in this area. To do this, governments and health care providers must intentionally and strategically test payment options that encourage health care providers to seek higher quality and value. The future of health care depends on it.