The Zebra's Stripes

The Task Force On The Funding Of The Health System (The Task Force) released its final report in February titled "Getting Our Money's Worth," in which it concludes that if the Quebec public healthcare system is to avoid going broke in the near future it must move toward privatization. This is significant for two reasons: 1) Claude Castonguay, Quebec's former health minister, the father of the modern Canadian healthcare industry, is The Task Force's chairman and, 2) Canada's socialized medical industry is mostly based on the Quebec model.

According to Castonguay's report, Quebec's $60 billion healthcare budget is being overwhelmed because doctor office visits are free to citizens. American economists have long predicted that nationalizing the U.S. healthcare system would result in increased cost (in the form of taxes) and limited services (in the form of rationing), eventually leading to a collapse similar to that now underway in Canada. The Task Force has called for a $25 per visit fee to discourage over-utilization of doctors' services, which, along with an increased sales tax, would go into a health-stability fund to pay for a proposed 3.9 percent cap on healthcare spending that is expected to result in a shortfall.

The report also suggests increasing privatization in hospital management, insurance and pharmaceutical systems and recommends, "that priority be given to the deployment of the electronic patient file in every health institution and clinic." I think they're stealing our ideas.

So, as America's political machine grinds us ever closer to national healthcare, our neighbors to the north speed skate in the opposite direction to survive the collapse of their system. Are there lessons to be learned? Definitely.

On another note, many organizations advocate measuring caregivers' performance as the necessary first step toward lowering the cost of healthcare. However, pay-for-performance (P4P) strategies are dependent on IT adoption and it seems likely that many physicians are holding back investing in IT until there's a standard information exchange protocol, which is delaying the entire healthcare consumerism movement. HHS and Medicare can push transparency, P4P and EHRs all they want, but so long as physicians practices refuse to adopt IT, it's doubtful the movement will take hold industrywide. For them, it'd be like purchasing the choo-choo on the promise that tracks will be laid on Tuesday.

My own doctor's office is a large multi-physician practice connected with one of the nation's most technologically advanced hospital systems, and it does not have a patient portal. They say, that when the investment makes sound business sense they'll have one.

The cart should always follow the horse. Consumers will readily start using technology that empowers their healthcare decision making once physicians adopt it, and physicians will adopt it once it's affordable, standardized and enables them to improve patient care without putting them out of business.