Healthcare’s Governance: What’s the Goal?

 

Common and central to the mission statements of Canada’s provincial/territorial Ministries of Health, so far as they are clearly articulated[1], is the overarching goal of protecting and enhancing the health of the population. Most then go on to focus on discharge of the Ministry’s responsibility for the development and leadership, i.e. the governance, of a system of healthcare services as the principal means of achieving that goal. These statements beg some questions:

  • Is population health really top-of-mind among Canada’s governments and the agencies they have established to govern healthcare?
  • If so, what elements need to be incorporated into the governed system to achieve that goal?
  • If we had one, to what extent would a smoothly functioning, integrated healthcare system protect and enhance the population’s health?

Fully 75% of people’s health is attributable to its social determinants – education, personal and financial security, housing, nutrition, supportive communities, and the like. The ‘repair shop’ functions of healthcare contribute much less, yet they claim the lion’s share of financing and attention. Judging from the reports and commentary available to the public, the operational objective of reducing waiting lists for access to hospital and physicians’ services is much higher in the priority order of governments and their Ministries of Health than is enhancing the health of the population. It appears that the pursuit of politically important but secondary operational objectives has overtaken and obscured the principal goal that, to be successful, every element in a genuine system must keep top-of-mind, especially its governance,

If enabling good health is the goal, home, community, and social services, now essentially after-thoughts, must be incorporated into the system. That would be best done by expanding the reach and responsibility of primary care, by incorporating into primary care teams health professionals charged with ensuring that the population for which the team is responsible has as ready access to home, community, and social services as they do to primary healthcare services. Always important, this is especially so now as Canada’s population ages with its attendant increase in multiple incurable but treatable conditions.

A smoothly functioning, comprehensive healthcare system is what Canada needs and should aspire to create. All its elements should be connected, each with its eye focused on the health of its served population as well as on the provision of care for those of its members suffering ill-health or injury. The necessary communication tools are available ‘off the shelf’ as are the highly qualified providers needed to create such a system, although some of those currently excluded, especially those providing community services, do need substantial strengthening. But what’s needed most is system governance with its mind and that of its many elements clearly and resolutely focused on the goal of helping Canada’s population be the world’s healthiest.

[1] and most of them aren’t


 

Authored by members of the Queen’s Health Policy Council:

Don Drummond
Chris Simpson
Duncan G. Sinclair
David Walker
Ruth Wilson

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