“Patient engagement is the blockbuster drug of this century” said Dr. Zayna Khayat; a great way to sum up her vision for the future of health care. A senior leader with the International Centre for Health Innovation, she and Dr. Ernie Lightman, an economics and social policy professor at UofT, led the Why Should I Care discussion on August 10 2013 at the Duke of York on health care sustainability. Both agree that major changes are needed and coming.
A great deal of health dollars are spent on the elderly and with Canada’s aging population, it’s no surprise that a discussion about healthcare sustainability largely focused on eldercare. Dr Lightman pointed out that many elderly people could be better treated in a community setting outside of expensive institutional settings. In other words, building more nursing homes will not improve the quality of care, but will dramatically increase the cost of care. He pointed to community groups, religious or otherwise that invest time and energy in their local groups, families and centers to provide support, activities, fellowship, and a helping hand to residents of those areas as ways of decreasing costs while increasing quality of life. Currently we have too many “bed blockers” – people who could be living well at home with help for a few hours a day from a nurse or other care providers.
On the innovation front, Dr Khayat related a story where she discussed how she used her iphone to video chat with her dad to fix a car problem. However, when she tried to do the same with her parents’ doctors she was not allowed. Old world thinking is blocking the ability of a new generation to help bring down healthcare costs.
Both speakers spoke about creating a model where patient should be more engaged in their own health especially through learning. Patients have access to a lot of medical information on the web which may better help them understand appropriate care rather than blindly following the recommendations of any particular health care worker. A flip side of this issue is that we pay doctors to be experts so it is not clear how investing our own time into this process to redo their jobs is an improvement.
Somewhat surprisingly, poverty is the most strongly correlated variable with poor health. It seems likely that a combined approach of education, health care, community services and jobs programs is the best way to address large scale societal problems. Khayat and Lightman even went as far as saying that rather than spending more on health, we should spend more on reducing poverty. As poverty goes down, so will our health care bills.
Our healthcare system was created at a time to deal with diseases. It was put in place to make sure doctors got paid. As people’s demands and expectations evolved, the system did not. As a result, we are paying for treatments and surgeries to fix the ailments as opposed to prevent it. Dr. Lightman noted that nutritionists and massage therapists are not covered under the OHIP system. It would be cheaper to help patients with healthy eating for muscle repair before obesity develops into disease or minor injuries require surgery.
Both Drs Khayat and Lightman agree that the ounce of prevention is much more sustainable than the pound of cure. The healthcare system does not need more money, it needs us to reallocate it better.