Learning From Canada

I know we are all used to thinking that our healthcare system is better than Canada’s but it might be worth really taking a look.  The reason we do this is not so much to compare our system with theirs but rather to see if there are things we can copy and perhaps even use to improve our system as health reform unfolds.  This issue was brought home to me when one our Chicago hockey players (remember hockey?) held a benefit last year to help with healthcare costs in our city.  He said he and his wife were so fortunate to have grown up in Canada where healthcare is so inexpensive and so good that he felt he needed to help out those less fortunate in the US.  He meant nothing nasty with these remarks but it really hit a nerve and I thought it was worth exploring.

Take a look at Cheryl Clark’s recent article for some very interesting perspectives on the Canadian system.  Note that costs in Canada have risen at a much lower rate than in the US and seniors have to pay way less in terms of coinsurance or deductibles.  Perhaps the most striking difference is the fact that Canada pays just 16.7% in administrative costs while in the US this number is at 31%.  This is a huge amount of money when one considers that healthcare is 16% of our GDP.  This is not a surprise really as we see it every day when we visit our hospital and physician customers or when we get billed for going to our own physicians.  Waste is everywhere.

There are a number of important lessons we can learn from the Canadian system.  They seem to place a high emphasis on primary care physicians as a way to both control costs and provide better routine care.  Specialists are truly specialists and get to perform enough cases that they really get good at what they do.  Perhaps both of these are issues in the US as we have too many specialists who are not as efficient at what they do and not enough PCPs to provide the access that is so crucial to controlling overall costs.  The bulk purchasing point made in the article should also be carefully considered by our industry as we know the prices paid in Canada are often deflated from what is paid in the US.

To me the most interesting part of the article is that it is a comparison with Medicare in the US where most experts think our system is most efficient and where the patients have a high level of satisfaction.  Think about what this comparison would look like if they were discussing our Medicaid or even many of our commercial insurance programs.  The solutions seem so obvious yet so tough to implement.  We need to get all the redundant work out of the system and yes much of the paperwork needs to go away.  There needs to be more consistency in the system even if we continue with a system of many free market payers.  Yes we may do many things better than the Canadian system but we should take the time to learn from them so we can improve our system even more.  If nothing else perhaps it is worth really studying other healthcare systems around the world and quit talking about the person who needs to come down to the US for that special operation.  As a wise KOL once taught me the plural of anecdote is not data.

It might be worth bringing this lesson down to a more practical level.  How often do we study the way sales and marketing is done in other countries to see where we could improve what we do?  How about even looking at different companies in the US both big and small to see what can be learned?  How about even looking at other industries?  Too many people think that by even looking they are admitting in some way that what they currently do is flawed.  They think there is a level of disloyalty when they point out how well another company seems to be handling a difficult problem.  Best practices don’t always need to be home grown.  The wisest professionals will adapt the best things regardless of where they find them.  They always recognize there is room for improvement and quite frankly believe that survival depends on it.

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