Paradigm Freeze: Why It Is So Hard to Reform Health Care in Canada; Harvey Lazar (Editor), Pierre-Gerlier Forest, John N. Lavis (2013)
This May Hurt a Bit: Reinventing Canada’s Health Care System; Stephen Skyvington (2019)
It is sometimes useful to read two similar type books at the same time in order to contrast them and see different angles. This book review is part of a series looking at books in the technology, health services, and innovation domains.
This month I decided to read two books about re-creating or reforming Canada’s healthcare system.
As many of us know, improving the healthcare system in Canada is extremely difficult. It’s difficult working from outside the system as an academic or an entrepreneur and it’s difficult working from inside the system as an employee.
Therefore these two books “Paradigm Freeze: Why It Is So Hard to Reform Health Care in Canada” and “This May Hurt a Bit: Reinventing Canada’s Health Care System” seemed like good readings to hear what other voices are saying.
First, I think we all agree that there is always room for improvement.
Paradigm Freeze focused on looking at 6 policy issues in 5 provinces over the time span of 1990-2003. The six policy issues were regionalization, needs-based funding, alternative payment plans for primary care physicians, for-profit delivery, waiting lists, and prescription drug insurance coverage. The provinces included were Alberta, Saskatchewan, Ontario, Quebec, and Newfoundland and Labrador.
This book seemed like a long read and in my opinion seemed to repeat itself alot. It also seemed like they tried to impose an academic methodology to it – while a narrative would have probably have worked better. Basically, they summarized which provinces did what in a matrix table at the end.
What I got out of the book was that change only happens at the start of a provincial political change-over and there basically needs to be a crisis for reform to happen. It needs to be quick, otherwise opposition towards the status-quo develops. This is a really important point – as when you read about the opposition to many things that we now view as extremely valuable or core – you wonder why the opposition. Two examples were the physicians and pharmaceutical companies’ opposition to Medicare and the other was physician autonomy around wait-list reporting (allowing it to be voluntary).
The book also goes into some depth of looking at the various provinces and the commissioned reports (grey literature) that essentially details the changes required. Prescription drug insurance is always one of those required suggestions that never seems to move forward.
There were some good one-liners in one of the chapters. I’ll need to pull them out and add them to this review.
What I would have liked is to have a concluding chapter on what are some of the big policy issues facing Canadian healthcare in the future. Or worse yet – if the big policy issues are actually still the same six covered from the 1990s.
Paradigm Freeze concludes saying “Without some sort of insurmountable disruptive force, either a major shift in medical science or technology or a catastrophic economic or political crisis, fundamental health policy reform in Canada is unlikely”.
The second book was “This May Hurt a Bit”.
I was actually looking forward to reading this book — thinking that it would present some interesting ideas – especially since the foreword was written by Brian Day (a physician challenging the government that private clinics/delivery should exist).
First, I didn’t care for the writing style at all. Instead of focusing on the argument or debate of many of the issues, he instead starts the conversation by trivializing the person.This is exactly the kind of politics that I despise. However, it makes sense as the author is a political advisor. He also wrote a lot about himself – so a lot of one-off personal experiences that he is hoping to define policy.
Second, I didn’t find any of the ideas he suggested to be novel or insightful.
But then a light appeared near the end. He referenced two of my colleagues. Whoa. My colleagues were not even aware they were mentioned in the book – so I think I just sold two copies.
Two pages were dedicated to Dr. Daniel Dutton (p172-174). “In January of 2018, a study conducted by Dr. Daniel Dutton of the School of Public Policy at the University of Calgary was made public”…. and then finishing with “So, while Dr. Dutton’s study is both useful and timely, it too will likely sit on a shelf somewhere, ignored by those who have the power to make a difference”.
And then another light…
“A 2012 study by J.C. Herbert Emery…” (page 189). But this one was only half a paragraph long.
That was pretty impressive, especially in a book that didn’t reference many studies at all.
It should be noted that the book “This May Hurt a Bit” was centered around the increasing cost of healthcare and the public’s inability to access timely care. I think we all agree on that. However, ideas like introducing Tax-Free Medical Savings Accounts seems odd in a country where 50% of people are hundreds of dollars away from defaulting on mortgages/loans, aren’t saving for retirement, and are already over extended.
Instead what needs to be focused on is accountability and innovation in the Canadian healthcare system.