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Health Minister Leona Aglukkaq says she is ‘concerned’ that women may not have been told of the Alysena recall in a timely manner.Adrian Wyld/The Canadian Press

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Bending the healthcare cost curve.

Get used to that expression because you're going to hear it often in the months and years to come.

What does it mean? Essentially, healthcare costs, if plotted on a graph, have been rising relentlessly for decades: The line goes up at a 45-degree angle. Bending the cost curve means taking measures that flatten out the line.

How you do that is simple enough in theory: Zero growth. Hold the line on spending. But doing so in practice is quite another matter.

In the U.S., health spending has actually leveled off, much to the surprise of economists. But it took one of the worst recessions in history to temper the appetite for health services and there is no guarantee the line won't shoot upwards again.

In Canada, most provinces are talking tough and vowing to hold spending increases in the 0 to 2 per cent range. In a single-payer system, bending the cost curve should be relatively easy.

But, as a new paper from the Institute for Research on Public Policy notes, short-term restraint is invariably followed by panicked spending that more than makes up for cutbacks. (One can't help but think of the quip: "Quitting smoking is easy, I've done it thousands of times.")

So it has been with our efforts to rein in health spending: The curve bends, but not very much or for very long.

In the article "How To Bend the Cost Curve in Health Care," veteran health policy analyst Steven Lewis and long-time health administrator Terrence Sullivan argue that traditional restraint measures haven't worked and they won't work this time around.

Rather, they take the position that our financing methods and delivery systems are designed to drive up costs and, if we want to bend the curve permanently, fundamental cultural change is required.

Mr. Lewis and Mr. Sullivan acknowledge that this won't be easy. Governments, healthcare organizations and practitioners will need to leave their comfort zone and abandon conventional practices. A fundamental transformation is required.

The authors propose 10 major shifts that are needed if politicians and governments are serious about making the rhetoric about bending the healthcare cost curve reality:

  • Bend the needs curve. In other words, you need to dampen demand for care by investing in prevention and secondary prevention in particular. That means intervening so patients with chronic conditions like diabetes, heart disease and COPD don’t get worse. Practically that requires investing in rehabilitation and homecare to reduce hefty hospital costs;
  • Tear up the contracts between governments and medical associations and start over again. Get rid of traditional fee-for-service payments and emphasize payments based on outcomes;
  • Eliminate regulations that prevent health professionals from working to their full scope of practice to eliminate a lot of silos. Re-think the “sacred notion” that health professions should be self-regulating;
  • Make primary care the backbone of the health system to ensure better, more convenient care. Stress teamwork, beginning with health science education, and make it a condition of licensure for health professionals;
  • Root out “useless, burdensome and harmful service use.” In other words, clamp down on ineffective and overused procedures like some routine diagnostic tests that provide little useful information;
  • Address all-too-common variations in practice to ensure care is appropriate. Researchers have identified more than 100 overused tests and procedures;
  • Use incentives, but use them strategically and wisely. Too often, in Canada, incentives reward volume targets (like number of hip replacements) or adherence to processes (proportion of diabetics receiving a specific test) but governments tend to not reward quality or outcomes, sending mixed signals;
  • Seize every opportunity to lower prices. While Canadian provinces have a single-payer system they rarely use that advantage to be a tough negotiator and smart purchaser;
  • Make basic structural reforms to make it easier to provide cost-effective care. Break down silos and bundle budgets to create natural incentives to substitute less expensive care, such as home care instead of hospital care.
  • Involve the public in a conversation about the need to reform the health system. “That conversation begins with truth telling,” the authors write, in calling for the public disclosure of much more performance data, such as re-admission rates in specific hospital wards and surgeons’ mortality rates.

In short, Mr. Lewis and Mr. Sullivan argue that the only way to truly bend the cost curve is not by cutting spending but by changing fundamentally how we spend.

"Timid policies, exhortation, gentle measures and avoidance of difficult conversations will fail to bend the cost curve or achieve both widespread efficiency and quality improvement simultaneously," the pair writes.

It is our old way of doing things that needs to bend, and that requires a break with the past.

André Picard is the health columnist at The Globe and Mail.

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