A Fork in the Road

Allan and Nan
Allan Hamilton visits his ex-wife Nan in Brampton's William Osler hospital on May 28, 2011. (CP/Ian Williams)

Transforming healthcare

Audio: Metro Morning's Mary Wiens speaks to Don Lenihan and Matthew Mendelsohn. Listen audio (runs 6:22)

Healthcare is the single most expensive item in the provincial budget. The financial crisis may be a perfect time, not to cut services, but to build a better system.

Our provincial government - like governments all over the world - faces a massive deficit, along with growing costs, especially for healthcare.

Better health with less cost through technology

Matthew MendelsohnMatthew Mendelsohn

Healthcare eats up 45 per cent - almost half - and growing of the province's budget. That won't continue, says Matthew Mendelsohn, co-founder of the Mowat Centre for Policy Innovation. But he says that doesn't have to mean that services will get worse.

Mendelsohn points to major technological changes and innovations in healthcare, from investments to reduce wait times to the advances in measuring quality of care. Unfortunately, says Mendelsohn, the changes have done little so far to reduce government spending. He believes transformative change is possible if policy makers begin to shift their thinking about healthcare as being primarily about doctors and hospitals and learn to see healthcare as a high-tech industry.

"The healthcare system in ten years I think will be much less doctor-driven, will be much less hospital-driven but it won't be producing worse results. I mean in the 1990s, the conversation was about cutting hospital beds, and everyone was concerned - well, you're cutting hospital beds! Keeping people in hospital is not a good health solution. You want people out of hospital, and in most cases, it improved health outcomes. It was better for people to be at home. It's a sign that the medical system is improving. You don't have to have someone in hospital for five days. You can release them the same day. That's because technology and pharmaceuticals are improving, not deteriorating. And so we have to start thinking about health as not only about hospitals and doctors, but a bunch of other things."

A broader perspective reveals hidden connections

Don LenihanDon Lenihan

Don Lenihan, the Vice-President of Canada's Public Policy Forum, agrees that our vision of what healthcare is needs to expand. And he adds that any real transformation of how government works will go beyond technological advances. Lenihan is the author of Rescuing Policy: The case for public engagement (1.7 MB pdf).

In an increasingly complex and interconnected world, Lenihan says governments have to learn to become more collaborative and develop policies based on shared responsibility between government and citizens.

Drawing on original research in facilitating a series of Canada-wide conversations to revise the Canadian Sport Policy, Lenihan says there are important lessons in that process for how that collaboration can work.

The original sport policy, developed in 2002, focused mostly on big competitions and games, such as the Olympics and the Pan-Am Games.

As part of a sport policy renewal process, Lenihan conducted workshops across the country with people who had a much broader perspective of the public goods that sport can deliver.

"What we've realized about sport in the past ten years is that it's an enormously important tool for achieving all kinds of other goals. Like youth at risk - if you want to keep kids off streets, put them in a soccer league, right? If you want to get people healthy, get them doing sports. If you want seniors to be active and so on, get them involved in leagues. If you want to integrate new Canadians in the community, get them involved in sports. Sports turns out to be a powerful tool for a whole bunch of things. It's a tool of community building. But we never thought about it that way as government before. So the politicians themselves stand back and say why didn't we think about it that way before? And why don't we use it as a lever to achieve other policies far more effectively?"