How do facts and values align when we talk about health care?

In part one of our series 'Facts and Values,' we examine health care. Researcher Anne Snowdon walks us through what she calls a 'misalignment' between what Canadians value in health care, and what we measure; health lawyer Amil Attaran explains how Canadian media gets the health care story wrong.
Canadians hold health care as one of their most important values. (CBC)

In The 180's new fall series, we examine areas where public conversations involve both facts and values, look at where those two concepts overlap, and what we can learn when we pry them apart.

Health care, especially public health care, is often seen as a critical part of the Canadian identity. Debates over health care are a place where values sometimes diverge from reality, and sometimes it's even unclear what our values are. 

Anne Snowdon, Professor at the Odette School of Business at the University of Windsor, says if we want to improve the Canadian health care system, we need to focus on people's values. 

A value is a quality based on a person's principles or standards. What we deem as very important to our lives or the quality of our lives.- Anne Snowdon, University of Windsor

Snowdon is the lead author of a 2012 paper called "Measuring What Matters: The Cost vs. Values of Health Care." While the Canada Health Act is based on values of universality and public administration, Snowdon's paper finds people's values are much more personal.

Canadians value a health care system that offers personalized care, and is effective at keeping them healthy. The paper argues that, from a values perspective, we know what people want, but we don't have the data to assess whether those values are being met. 

You can't manage what you don't measure. We need to measure many more indicators that are more closely aligned with what consumers value. So, when you have an elderly person who comes into a clinical setting, she's just had a fall, and her health goal is to remain independent and active and live at home, we don't measure whether our care... actually executed on that.- Anne Snowdon, University of Winsor

Snowdon would like Canadians to consider, what they value most in a health care system, and question whether or not the system delivers on those values. But, there's a challenge with applying values to health care. In big, often ideological debates such as private versus public delivery of health care, sometimes facts get lost in the discussion. 

When it lands on the - oh should it be private or should it be public - the question we really need to ask is, is there evidence that that privatised opportunity offers better care? I can't find evidence that says yes, a privatised model adds value in terms of quality, safety, access. Timeliness? Of course. But do you want to trade off timeliness for the others? That's a value based proposition.- Anne Snowdon, University of Windsor

While Snowdon would like to see the system more closely aligned with the values of Canadians, some researchers warn a values-based conversation over the privatization of health care services is taking up too much space in the public sphere. 

Amir Attaran, a professor in both Medicine and Law at the University of Ottawa, is one of the co-authors of a Canadian Medical Association Journal editorial lamenting that conversation. 

We at CMAJ demand to know why every discourse on health care reform must inevitably degenerate into ideological warfare... the perception of an irreconcilable conflict between public and private health care is being actively maintained by both sides of the debate because it serves the self-interest of the actors.- CMAJ editorial

Attaran points to media coverage of a case currently in BC Supreme Court between a private surgery clinic and the Province. While Attaran believes journalists have the best of intentions, he finds the reporting on the story superficial and distracting. 

Canada has had a public care system for decades now. As a practical reality, the courts aren't about to roll that back into non-existence. Even if Brian Day wins his case, it doesn't mean the death of medicare, and yet that's how the stories are presented.- Amir Attaran, University of Ottawa

To Attaran, unless we can have conversations that focus on facts, instead of ideological values, we miss out on pragmatic attempts to improve the system. 

Attaran says this ideological debate detracts from critical examination of the health care system, and that the media, while focusing on conflict, ignore vastly more important stories about health outcomes, and how people feel about the performance of the system. And if the media and politicians don't commit to having informed conversations based on evidence, the stakes are high. 

It might be your life, the life of your spouse or child, someone who you love very much. That person may go without appropriate care.-Amir Attaran, University of Ottawa


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