If I harm a pt by making poor surgical decision for which evid was available to guide me;there is recourse. How is gov’t different? #onpoli
— Dr. Shady Ashamalla (@AshamallaMD) June 1, 2012
Evidence-based policy. For those of us in the healthcare field, it resonates as an ideal. What better way to allocate resources than looking to the interventions with the best evidence and funding those? We can yield the highest return on our investment and ensure the best health outcomes for each dollar spent. We can reduce waste and free up resources for those interventions with highest impact. We can focus our research efforts on those areas which do not have good evidence to help us make better informed decisions. If we follow the evidence, we can ensure the best outcomes for society.
Sometimes to our surprise, lawyers, politicians and policymakers see things a little differently. They see health spending cuts as a matter not of evidence, but of priorities. Getting the budget under control now is more important than the potential consequences later. And though the medical profession may disagree about government’s priorities, this is exactly the job that we’ve elected these people to do. Of course, government isn’t immune from making bad decisions; certainly not. Should government be looking at social programs in other areas other than health to be curbing their spending? Education? Infrastructure? Taxes? Perhaps. But is it wrong to make controlling government spending a higher priority than potentially negative health outcomes? That’s a more difficult judgment to make, and one which society, not just the medical experts, needs to make, especially if it continues to hold dear the public healthcare system.
Controlling spending is now government’s priority, and health costs are a large part of that. To be clear, sometimes physicians forget that the government didn’t start by cutting their wages. There were priorities. The first target was generic drug prices — something that the Ontario Medical Association fully supported. Physician wages were valued over the potential loss of pharmacy services. Lower generic prices were valued over pharmacy closures, job losses and loss of services. That was then. (For good measure, there are further cuts to generic drug prices in the recent budget.)
I do know that lobbying on the premise that government acts are misguided, misinformed, or that they are ignoring the clear truth of the evidence isn’t going to make the government realign its priorities. Rather, it detracts from the more fundamental problem which government has in this new era of healthcare. As a public system, we lack an appropriate way to respond to the rapidly changing marketplace within healthcare. A publicly-funded systems is not nimble enough to respond to new technologies which decrease surgical times, or new processes which decrease drug manufacturing costs. Government moves slowly, and so funding is adjusted through peaks and valleys. It is inefficient, reactive, and emotionally charged.
What is clear right now is that the public isn’t paying a fair price for certain medical services or generic drugs. Government needs a better way to respond to these market changes long before they become a political crisis. Pharmacists were antagonistic to the government cuts in 2010. Physicians are taking the same approach now. Instead, we need to focus our energies and work with government to help improve the inefficiencies in our system to ensure a sustainable publicly-funded healthcare system for the future.
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