Greg Marchildon may not know yet whether his idea works, but he figures it’s got to be better than what he called the “buffalo dung” now used to analyze the cost effectiveness of the public health system.
Marchildon of the University of Regina’s Graduate School of Public Policy outlined his new framework to evaluate Canada’s health care at a public meeting at the University of Saskatchewan Jan. 28.
He said although he has to test his plan for weaknesses, he hopes it will make it easier for politicians and health-care decision makers to determine whether present policies help or hurt people compared to other provinces’ programs and then make adjustments.
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Marchildon, who worked on the 2002 federal royal commission on health led by former Saskatchewan premier Roy Romanow, said he was frustrated by simplistic snapshots of the system. He noted the waiting list concept of the Fraser Institute tends to offer an ideological viewpoint, rather than an accurate one.
He said too often the negative predominates.
“We usually think of health care as a drain on the economy, not as a leading sector, like it has been since 1945, much like the steel or auto industry.”
Politics often get in the way even when research has shown results that point to the solution, he said. He cited the idea of a guaranteed income for all Canadians. While studies show reducing poverty and income disparities create a healthier population, some political parties won’t accept the concept, he said.
After his speech, Marchildon said the way to counteract ideology in research is to work carefully and “put your biases in check.”
He told the audience of initial results from his framework, which compares the three prairie provinces and the Canadian average.
For example, the percentage of the adult population that is obese, according to 2001 data, is 20.4 percent in Saskatchewan, 18 in Manitoba, 16.5 in Alberta and 15.5 in Canada. The infant death rate then was 6.9 percent in Saskatchewan, 5.5 in Manitoba, 4.5 in Alberta and 5.6 in Canada. The 2005 figures for teen pregnancy per 1,000 girls are 36.9 in Saskatchewan and 36.2, 29 and 24.6 for the other jurisdictions.
While the numbers look bad for Saskatchewan, Marchildon noted the province is better on other measures. One is the sense of belonging, where people rated their connection with others as 69.3 (Sask.), 65.9 (Man.), 61.9 (Alta.) and 62 (Canada.)
On this measure Saskatchewan is ahead of the other provinces and “you want to keep that,” said Marchildon. The trick is to figure out what provincial programs are contributing to that.
Attitude of patients also plays in Saskatchewan’s favour when it comes to hip fractures. While the wait to get this injury looked at in hospital is longer in Saskatchewan than Alberta or the Canadian average, patients rate the quality of health care as higher in Saskatchewan than the Canadian average.
While Marchildon said the care for mental illness is declining in Canada, he pointed to another area where the country is improving. For avoidable mortality, an international study in 2008 placed Canada sixth in the world, with the best being France, Japan and Australia. The Scandinavian countries and the United States, touted as having better health systems than Canada, were all behind Canada in this death measure.
Saskatchewan and Quebec were the best in Canada in terms of preventing avoidable deaths, when heart disease is included. When heart disease is not included, Quebec had the best trend showing declining avoidable deaths while Ontario and Alberta were No. 1 and 2 and Saskatchewan fourth.
