5 bold moves the Sask. government could make in this budget to renew health care

The health care systems in Canada and Saskatchewan are notorious under-performers compared to other rich countries. The diagnoses of the problems – poor value for money, uneven quality, legendary access problems – are all accurate. 

Neither starving the system (mid-1990s) nor force-feeding it huge amounts of cash (1997-2010) jolted the system to a new level of excellence. We are a nation of fine-tuners and interest brokers. Big change is something to talk about rather than do. The system is a great, lumbering, habit-driven, $5 billion-plus beast. It is sometimes excellent and sometimes awful, but agile it is not. 

So what's a government to do at budget time?

Saskatchewan has acted boldly twice in the past quarter century. In 1993, the NDP government, faced with the direst fiscal crisis since the Depression, closed 52 tiny rural hospitals – a brave and sensible decision that cost the party its last vestiges of rural support for a generation and counting. 

The Saskatchewan Party government more recently bet $38 million on Lean, a well-intentioned experiment sabotaged by naïve faith in its magical powers and tone-deaf implementation. 

Given the checkered history of boldness, should we just lower our ambitions and leave the behemoth alone? No. 

The gap between aspiration and achievement is just too big. Health care needs a healthy dose of boldness. Here are five things the government could announce in the upcoming budget to show it is serious about real change.

1. Give real innovation space and let it breathe

The government should fund at least one large-scale project that would create a truly integrated health system. The world's best systems bring all of the services, from primary care to hospitals, under a single umbrella, and let the people who actually deliver care organize it to deliver high-quality, efficient services. 

The goal is to do less, not more. Such systems align funding and payment incentives with health goals. They encourage constant evidence-based experimentation and creativity, and team-based care. 

For example, the Southcentral Foundation in Alaska, serving a largely Indigenous and combined urban and highly-dispersed population, has organized itself into clinics where doctors, nurses, therapists, mental health workers, and others work seamlessly together. Its has reduced visits and hospital stays by helping high-needs people to take control of their own health and care. Leaders from Southcentral have been to Saskatchewan to share their knowledge and experience. Why not do it?

2. Get serious about eliminating waste

Experts routinely estimate that as much as 30 per cent of health care is either useless or harmful. Physicians have identified literally hundreds of overused tests, procedures, and drugs. 

Yet the rampant over-consumption continues. The government should fund efforts to get to the bottom of why and find strategies to change a culture that wrongly equates more with superior.

Exhortation doesn't work. It's essential to plumb the mindset of practitioners and find the keys to making them more comfortable with doing less when less is better. 

3. Become a leader in information

Make Saskatchewan a leader in providing the people who deliver care the best possible information to help them improve.

Doctors, nurses, pharmacists and others need meaningful, accurate, and timely data that tells them how well they are doing now, and where they can do better. 

This, too, requires a cultural change. Data should be primarily a tool for improvement, not judgment, and those expected to use it should have a say in what they receive.

If providers get to identify the data that will help them improve, then we – government, health care leaders, the public – should hold them accountable for acting on it. 

4. Get serious about a seniors strategy 

You can judge a health care system by how well it serves frail elderly people with multiple chronic conditions. Ours routinely fails, which costs people their health and the system huge amounts of money. 

A system that works for these people will look a lot different from what we have now. If it works for them, it will certainly be good enough for healthy, younger people.

Geriatrics is increasingly health care's core business. Policy, funding, and practice should make it the number one priority.

5. Be willing to fail

Finally, the boldest thing the government can signal in its budget is an intention to let the newly minted Saskatchewan Health Authority dare to fail. 

If you don't allow the authority to reallocate resources, invest in new approaches to care, and try out promising ideas that bubble up from the public, patients, and health care workers, then rename it. No government has successfully micro-managed its way to large scale improvement. 

No talented leaders will hang around a system that requires them to seek approval for every innovation. Extreme risk aversion is a death sentence for improvement. The surest sign that the SHA is failing will be if it has no interesting failures to report, and if the desire for peace crushes the prospects for change.

This column is part of CBC's Opinion section. For more information about this section, please read this editor's blog and our FAQ.