Health Care and Politics: An Insider’s View on Managing and Sustaining Health Care in Canada; David Levine (2015)
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.
Healthcare and Politics by David Levine (2015) was suggested to me several times as “worth reading” by someone who I think has rather good insight.
What made this book different from many of the others that I have read, is that as the name suggests, it covered politics. It was also written by a senior healthcare executive. Levine mainly worked in Quebec during the years 1975 to 2015, although he did have a stint in Ontario as well.
I found the middle part of the book the most interesting. The beginning and the end of the book covered some larger questions that are often asked about healthcare systems. Things like: why is it hard to find a family doctor, why are there long wait times in the ED, etc. Many of these questions have been covered in other books and their responses have often gone more in depth.
Levine is a supporter of the public funded health care system – but also addresses some of the issues around it. Being public, means that decisions take longer and they need to be transparent. This of course comes at the expense of being more innovative and the ability to rapidly address new challenges and opportunities. He also speaks about the civil service that may be overly self-protectionist and focused on self-preservation.
One of the statements that I appreciated the most was about increasing demand. Often people say that it is because patients are getting sicker. His response was that it is because they are getting better (which means they can come back later). Another insight he had was that nurses are the first to notice a deterioration in care. I’ll need to ask my physician friends more about that.
What I found the most interesting is that Levine advocates for increased primary care, even suggesting to his medical-school daughter that she go into that area. Often acute care physicians/administrators focus on the challenges in acute care and lesser for primary care. The daughter exchange is actually a rather good read, and insightful. Not only is the reduced salary of a primary care physician mentioned, but the main discussion is that primary care physicians often operate without a team to back them up, need to have a much wider area of knowledge (compared to a specialist focused on only one disease or procedure), and often function without immediate access to high-tech medical technology (such as diagnostic imaging).
Levine also wrote about how governments have an instinct to focus on funding acute care compared to primary care. One of the main reasons being is that you can always point at a new hospital for voters. He also made a point that a Minister of Health is not a CEO and breaks down the relationship between the Minister, the Health Board, and finally the hospital’s CEOs. And even in the case of being a CEO, you still don’t have alot of power, as you don’t have authority over the physicians (they being independent contractors represented by their medical association).
Overall, David Levine’s book is interesting and speaks to something new that I hadn’t read in previous books. I would include this as part of a reading list on the Canadian Healthcare System (note: I found this to be a harder read then others).