Dec 2, 2009

Technology and the future of public health care


A couple years ago I put out a report for the CCPA that crunched the numbers on health care sustainability (BC version here). The main finding was that public health care was basically sustainable in that it could handle projected increases in population, aging and inflation as long as GDP continued to grow at a reasonable rate (consistent with what we have seen over the past quarter century, anyway).

The real challenge facing health care is not a “silver tsunami” but has to do with health care technology, and a system that accommodates the introduction of new technologies that are tantamount to an increase in the total amount of health care services in the public basket. That is,  after population growth, aging and inflation have been stripped out, we see rising real health spending per capita over the past decade that can only be explained by increases in new technological capabilities, since we are not seeing an increase in long-term care facilities, home care services or other non-doc-and-hospital services that were part of the expansion of public health insurance coverage in the 1970s and 1980s.

I pointed to four areas that challenge health care going forward: new surgical techniques, including knee and hip replacements, that have grown far beyond the rate that would arise from population growth or aging alone; new diagnostic techniques, such as MRIs and PET scans; pharmaceutical drugs; and highly technologized end-of-life care. In these areas, we need to have a public system that determines what gets covered by the public system and what the evidence is to support inclusion. At its worst, these new technologies crowd out existing services, such as pressures on hospitals to close beds.

That’s all a long-winded summary as a set up to a great article in November’s Literary Review of Canada by Charles Wright. Wright is a surgeon-come-healthcare-consultant and he nicely adds many examples of the above problem based on his own experience in the system (as opposed to me, who dropped biology after Grade 10). Wright reviews evidence on costs and benefits of certain drugs and procedures in the context of the public system, but also dives into the “over-medicalization” of our society and the expectations that have been created about what is normal. He ends up in a similar place to my own piece: we have to decide about what the public system should cover and we should make those decisions based on evidence not slick advertising campaigns.

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