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News Release

MRG summary sheet for OMA Task Force Report on the Allocation of Health Care Resources

The Canadian Medical Association, in 1983, claimed that the Canada Health Act, which the Federal Liberal government was preparing at the time, did not address the important issues affecting the health care system. The CMA asserted that physician extra billing and other user charges were not a problem while underfunding, lack of chronic care beds, and poor access to new high technology equipment were the "real" problems.

The CMA established a task force in that year to investigate the allocation of health dollars and manpower in light of an ageing population and increasing dependence on medical technology. The chairperson was Joan Watson, the noted consumer reporter and former host of CBC's Marketplace. The other members were the Hon. Pauline McGibbon, former Lieutenant-Governor of Ontario, Roy Romanow, former Attorney-General of Saskatchewan, Dr. John O'Brien Bell, and Dr. Leon Richard. Both of the physicians were former presidents of the CMA. The Task force travelled the country and heard briefs from hundreds of individuals and organizations. The CMA estimated the cost of the Task Force was over a half-million dollars. The Task Force reported to the CMA council in August of 1984. The Council referred it to the Board of Directors for further study. The CMA has taken no further action.

After spending over $500,000 on the Task Force the CMA decided to charge its members $15 for the report (for five or more copies the second and subsequent copies are $5). According to the CMA as of March, 1986 approximately 9000 copies had been distributed with many going to non-physician organizations and some going out of the country. There are 45,000 physicians in Canada. At this point very few physicians remember the report or its contents. The Medical Reform Group wishes everyone concerned with health care could read the report. This is not because it is the only such report or even the best. However we feel it is very high quality as well as readable and concise. It also reflects the concerns of consumers and providers of health care. We feel it is significant that it was published by the Canadian Medical Association which along with the Ontario Medical Association must share the responsibility for not sending it to their membership. The members remain, to a great extent, ignorant of the true issues affecting the health care system. They are understandably concerned about their patients and do not have time to analyze the issues in detail. That is what the Task Force did. The blame for the widespread ignorance of the profession lies squarely with the leadership of the Medical Associations.

Copies of the report may be obtained by writing: Reports, Canadian Medical Association,.P.O. Box 8650, Ottawa, Ontario. KlG OG8.

The Funding of Health Care

The Task Force found that it is extremely complicated to assess the proper amount for a country to spend on its health care system. There are the pressing demands for scarce resources from other sectors of society. Some of these sectors may in fact produce more health than the health care system. For example a program to reduce drinking and driving through the attorney-general's department or providing better housing for those on social assistance may produce more "health" than a new transplant program. The examples are ours but the Task Force did recognize, as many physicians' groups appear not to, that we live in a society with a fixed number of resources. Canada is wealthy compared to other countries but even here we must balance the needs of one part of society and the needs of the rest.

The Task Force did find evidence of some inefficiencies within the present system. Professor Robert Evans of the department of economics at the University of British Columbia reported that the average length of stay in a Canadian hospital after an uncomplicated delivery was 5 days while it was 2 days in many parts of the U.S. He said further that the average length of stay in Canada after a myocardial infarction (heart attack) was approximately two weeks in Canada and one week at Duke University Medical Center. Given the evidence of existing inefficiencies the Task Force could not say there was overall underfunding of the health care system. To quote the Task Force:

"To establish that the Canadian health care system is underfunded requires convincing evidence that:
* spending more money will indeed provide a measurable improvement in health, and that
* this improvement is greater than that which could be achieved by spending the money in some other way." (p.104)

"We cannot assess the extent of existing inefficiencies, and because there is no guarantee that putting more money into the system is necessarily the best way of improving health, the Task Force cannot make a clear cut recommendation. Indeed the Task Force suspects that the method of organization might be the main culprit. A more equitable distribution of resources may be the solution to the problem." (p.112)

"Because the evidence is contradictory and inconclusive, the Task Force does not support the contention that there is underfunding generally in Canada." (R.116)

The Care of the Elderly

Many organizations and individuals, physicians and others, have claimed that we need more institutional beds for the elderly. Stories of "bed-blockers" preventing needed admissions abound. These unfortunate elderly in acute care beds have been blamed for deaths of younger people and a whole range of other problems. The Task Force found that Canada has one of the highest rates of institutionalization for its elderly of any country in the world. Its institutionalization rate of 9.45% for people over 65 is 58% higher than Australia (6.0$), 80% higher than the U.S.(5.3%), and 90% higher than Great Britain (5.0$). This does not take anything away from the problem that a doctor working in an emergency department faces but these figures do point to a fundamental problem with the way we deliver health care, especially to our elderly.

The Task Force commissioned the prestigious consulting firm of Woods Gordon to investigate the impact on the health care system of our ageing population. The consultants looked at the effects on the system if there were no changes in our present delivery methods and the effects if there were certain specific changes in health care delivery methods. They found if there were no changes Canada would need to construct one thousand new 300 bed chronic care facilities. As of 1981, according to Statistics Canada there were less than 500 facilities with over 100 beds.

The scenarios which they investigated included decreasing the new rate of institutionalization to 6.0% (the same as Australia), decreasing the inpatient utlilization of mental health facilities to the levels in Saskatchewan as of 1981, and decreasing the average length of stay of non-elderly by one day. Although it would not be easy to change the system quickly, all of these scenarios are distinctly possible. These changes would reduce the . demand for new chronic care beds by 60% by the year 2021. To quote the Task Force:

"All four scenarios demonstrated that future increases in utilization (and revenue requirements) due to the ageing of the Canadian population, could be substantially modified by shifting a portion of the demand to lower cost alternatives." (p.28)

The Task Force was adamant about the need to reduce, not increase the number of elderly in institutions.

"...if we continue to put old people in institutions at the rate we do now, the costs will not only be prohibitive, but we will perpetuate the callous practice of "warehousing" the elderly. Old people do not want to live in institutions." (p.37)

The New High Technology

We are fascinated by new technology. The Task Force reminds its readers that this fascination is not new. The same process we have undergone in the past decade with the CAT scanner was passed through with the stethoscope in the early 1800's. What is different is the resources that the new technology can consume. The Task Force found that both the consumer and provider of health care are sometimes "mesmerized" by new things and that oftentimes our machines are not all we think they are. The Task Force found that new technology is poorly evaluated and in fact may not always be doing good. To quote from the Task Force:

"It seems we are exposed to at least some, if not considerable, risk from untested technology." (p.52)

"Although some modern technologies can indeed achieve remarkable results, it would appear that there are others which may in fact be useless or even harmful." (p.66)

There was a recent example of this problem. A Canadian group reported their results of a multi-continent study of a surgical procedure that was claimed to prevent stroke (EC/IC bypass). They found that the operation provided poorer results than non-surgical treatment. Prior to the release of the study findings there were surgeons who were concerned there were not enough facilities to provide the operation. Unfortunately, the Task Force comments that proper evaluation is expensive itself but can we afford otherwise?

The Task Force also found that "old" technology contributed greatly to the cost of health care. The use of routine blood and urine tests has increased dramatically and the Task Force pointed to physicians to control these costs. To quote from the Task Force:

"...since it appears that the 'everyday' technologies are contributing disproportionately to the overall cost, we urge that means to control their use should be investigated, such as by placing responsibilities on the practising physician, and monitoring clinical practices." (p.67)

The Task Force did not say that physicians were at fault for the problems associated with the use of technology but they clearly saw that physicians had the major responsibility to assess it and use it wisely.

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