By Jim Murphy Vice-President Healthcare Strategy and Business Development
Is the above image a picture of a lake, a forest or a mountain? Or is it indeed the holistic view of the great Canadian Rocky Mountain experience. You see yourself at the top of the mountain or in a canoe on the lake and you can do this virtually by just looking. They are not singular parts but a whole that when considered together has inspired great music, art and literature.
The Canadian, and perhaps, North American healthcare system is very similar except that we have a "huge" problem trying to see it all at once. We have organized ourselves around our silos based on the way we seek, provide or pay for services. Historically this has been linked to a place a provider or a plan. I submit that this has prevented us from taking collective action to fix what ails the system.
Even in Canada where we have a single payer system and a legislatively mandated requirement to allow for portability and universality we still manage our health care system based on geographic location,(the Provinces), clinics, hospitals, long term care facilities and yes even in the patient's home. However as a Canadian I cannot get the same access to healthcare service in different provinces or even within one province from one location to another. If I receive primary care in a capitated interprofessional team environment I have a completely different experience than I do in a sole practitioner fee for service clinic; even though these might be located in the same community and funded by the same provincial agency.
I know that several Provinces are working diligently on this issue as I write this. I also know that the Federal Minister of Health has just finished meeting with her Provincial counterparts to talk about funding and delivery of services. There have been attempts at incentives, value based reimbursement, penalties, funding envelopes etc. and many have delivered on promised outcomes. We also know that new providers want to work in a team environment supported by technology and peers from across the healthcare disciplines. Perhaps with this next round of discussions, strategies and reforms we will see a universal approach to funding and delivery that will both meet the needs of providers and scale to meet the needs of the population.
I work with an organization that was founded on the idea that care in its broadest sense can be virtualized and that this is the best way to provide access and scalability. I hope that when new designs are considered that the concept of surrounding people, their families and communities with services regardless of where they live or when they have a need will take precedence over investments in physical spaces. Healthcare can scale but only when you look at the entire picture at once.