By DAVID ZITNER (AIMS Senior Fellow)
Ordinary citizens are stuck without the information necessary to make personal and political choices about health care.
About half of government program spending is on health care. Yet, no one knows if citizens are getting value for money or if the current approach creates more harm than good. The health authority can tell you it spent billions it cannot tell how many people were better or worse after care or harmed by waiting.
When governments interfere with access to care and health care activities they should report whether care improved or was worse.
How much better or worse off are Nova Scotians because the NS Health Authority tinkered with primary care? We just don’t know. Information to resolve the controversies is not available and government seems to thrive on continuing controversy.
When information is missing, health care must be political.
Government could easily prevent continuing controversy by publishing regular and reliable information about access to care and the results of care. Unfortunately, senior health administrators pretend that measuring results is difficult and consequently refuse to give the public the information they need. In fact measuring results in health care is easy, and easy to understand.
Each individual knows how much they suffered while waiting and how much better or worse off they were after treatment, but no one bothers to report this information.
Simple measures allow people to assess their own health care.
People visit doctors because they want to feel better, do more, and live longer. Every patient knows whether they are more or less comfortable after treatment. They know if they have suffered temporary discomfort after a procedure and subsequently if their comfort has improved or deteriorated.
Every patient knows whether they function better or worse after care. People know if they are better or worse at performing activities of daily living. If a patient had surgery on a hip or knee joint they know afterwards if the joint is more flexible or more mobile.
People also understand how to measure likelihood of dying. People recognize that abnormal laboratory tests, for example, high cholesterol, high blood sugar, and abnormal heart rate lead to predictions of shorter life span. Successful treatments reduce risk factors.
In short at every visit clinicians evaluate comfort, and function, and your chances of dying. Useful health information systems capture this information from clinical encounters enabling administrators to know about health-comfort, function and life expectancy- before and after treatment and while waiting.
Controversies in health care would be resolved if government fulfilled their governance and evaluation function by insisting the health authority report on the decreases in comfort, function and life expectancy resulting from the new policies. If Authority policies improve health the changes should also be reported so we could celebrate the improvement.
Measuring suffering while waiting and changes after care would support government efforts to allocate resources where they will do the most good. Appropriate measurements would also reduce arguments between people who support one or another way of managing health care.
Without measurement we are stuck with a system where government proclaims they are improving care, opponents retort that health policy is making things worse. And, ordinary citizens are stuck without the information necessary to make personal and political choices about health care.
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David Zitner, MD, is a Senior Fellow at the Atlantic Institute for Market Studies (AIMS.ca).
