How far have we come since the Romanow Report – and how far do we have to go?
Six years ago the Canadian government released the Romanow report which made recommendations on the future of health care in Canada—a perennial priority issue for almost everyone. This report also formed a partial basis for the Action for Health Project. Dr Ellen Balka, the principal investigator for the research quoted the report in her proposal stating that “leading-edge information, technology assessment and research are essential foundations for all of the reforms outlined.”
Kjetil Rodje, a research assistant with the project along with Corlann Gee Bush, a research associate, examined aspects of the report in relation to these views on information technology and health. They described how Canada’s unique national infrastructure has contributed to the development of a certain type of information technology but added that the use and development of these potential tools have not been studied or examined in any great detail. In their article, published in the Canadian Journal of Communication last year they suggest that the call to “think outside the box”—something suggested in the report— is “heard but not answered.”
Most Canadians have long forgotten about the Romanow report, more properly termed the Royal Commission on the Future of Health Care in Canada. In fact, the entire debate about health care seems to have been sidelined in this election year as more pressing problems of environmental concerns and economic uncertainty dominate every party’s agendas.
But the issues addressed in the report and the technology issues researched by the Action for Health team are as relevant today as ever. Some might even argue they are becoming more urgent by the day as the landscape of health care in Canada changes. Take for example the announcement recently of 130 for-profit clinics currently operational, offering everything from MRI scans to surgical procedures.
The parallel private debate is certainly not new and constitutes a problem that won’t be solved easily. Here too technology plays a role, as for-profit clinics offer the latest and best in equipment and the publicly funded sectors make do with what’s available, outdated or not. However, the way technology factors into solving the wait times and access issues and the lack of enough doctors and nurses in the system is a little more elusive.
Perhaps what’s needed is a different perspective. The Romanow report focused on the core system, hospitals, emergency rooms, surgical procedures. But technology can help in many aspects of the health system, including prevention initiatives, the development of public health policy, areas that are currently peripheral or marginal such as palliative care. We sometimes forget that the health care system is not just about intervention when someone becomes ill.
Reform will have to address some pretty fundamental and philosophical concerns, issues that go well beyond whether to use technology in a given situation or how to implement something that may save money in the long run. We need to ask ourselves whether continually spending more money on the system translates into better health care for everyone. And with an aging population making increased demands on every part of the health care budget, the counter argument for just spending more is that eventually the money just won’t be there. After all, those aging boomers are using the system but no longer contributing towards it in the form of tax dollars. Technology is part of this too, as equipment becomes more and more expensive. CT scanners and MRI machines, now a standard part of care, cost between one and two million dollars apiece.
When people die they no longer cost anything, a crass way of looking at health care economics. But the very technology that is helping people live longer is also driving up costs. And everyone wants the gold standard in procedures, and why not? Add to that increased salaries for everyone from housekeeping staff to cardiac surgeons and the problems only seem to be escalating.
The role of technology as a way to save costs and increase efficiency doesn’t really address these big picture issues.
Researchers Rodje and Bush point to the recommendation in the Romanow report that an institute be formed to evaluate the implementation and use of technologies in the health care system. This would work at arm’s length and provide policy makers, funders, and health care professionals with the information they need in order to make informed decisions about when and how to move forward with technological solutions. But they add that this would add another dimension to the health care debate, namely, what are the wider implications of such a structure? Would it translate into better care for individuals? Would citizens be better served and perhaps more empowered to help themselves stay healthier?
These are questions that everyone in Western systems is asking. Researchers will continue to play a role in attempting to find answers. The Action for Health project began the process but it will be up to others to continue it.
Questions or comments? Contact Guenther directly at firstname.lastname@example.org