Driving change through consumer engagement

Health systems worldwide are challenged by the growing costs of health care and the increasing demand for chronic illness management within aging populations.  Innovation has become central to the agendas of most health systems to overcome these challenges and achieve sustainability. A recent analysis of seven OECD comparator countries identified numerous learning opportunities for Canada.  When we looked at health system governance in these countries, what was most striking was the role of consumer choice in driving change and innovation within health care. The countries that fostered consumer engagement – that is, helped their patients take a more active role in managing their own health and wellness – were able to achieve significant health system quality outcomes such as low wait times for emergency care, lower hospital occupancy rates, and lower health system costs per capita.

These results should come as no surprise. Countries with social insurance models of health care (Germany, Netherlands, France) rely heavily on consumer choice to select health care services through private insurance companies. This active role of consumers drives market competition for health services. Even in universal health systems such as U.K. and Australia, which have a similar structure to the Canadian system (state-as-owner/operator model; principles of equality and universality, public insurance offered by the state in combination with co-payments, out-of-pocket payments and varied levels of private insurance), consumers purchase private insurance for specific health services, which empowers consumers to influence health care and services.

The Netherlands has implemented a community-based care model referred to as ‘Dutch Personal Health Budgets’, in which consumers are given personal health budgets to manage, allowing them to plan and negotiate their own health care services. In this model, consumers have a clear and active decision-making role and are able to make their own choices in selecting service providers and hiring care staff, using either spending vouchers/credits or the cash provided to help cover medical expenses.  This may include assisted personal care and daily living, nursing care such as help taking medicines, support services such as daycare or rehabilitative care for managing a disability, and short stays away from home including respite care. The benefits for patients include choice of carer(s) and increased adherence to their prescribed regimens.

Evidence in comparator countries also suggests that a consumer-centric model of care encourages patients and doctors to better manage their health, curbing the likelihood people will end up in an emergency ward or costly acute-care hospital bed. For instance, in countries with social insurance models of health care (Germany, Netherlands, France), consumers and health providers are incentivized to participate in community based chronic illness management programs that focus on health, wellness and preventing exacerbations.

In 2002, Germany introduced disease management programs (DMPs) to its health system. Participation in DMPs is voluntary, but exemption from out-patient fees and co-payments encourages patient enrolment. Providers are also incentivized via lump sum payments. Given that primary care physicians take on the role of coordinating care for enrolled DMP patients, the programs are helping to reinforce the focus on primary care and chronic disease management in the German health system.

A DMP for the management of type 2 diabetes enrolled over 2.5 million active patient participants. Significant differences were found between patients who enrolled in this program compared to those who accessed usual care, including: significantly better involvement in decision-making, greater understanding of their care, improved goal setting, more confidence in their treatment plans based on their specific circumstance, and demonstrated improvements in follow up and coordination of care.

Even the aforementioned similarly structured health systems of the U.K. and Australia have system-wide community-based models of care that bring services closer to people in their communities and foster consumer engagement.

In Canada there has been little evidence to date of leveraging consumers to drive innovation in our health systems. As our OECD rankings on quality, outcomes and cost show, we can no longer afford to miss this mark.  We need to create a new, consumer driven culture in our health care system, and it needs to happen now.

This isn’t about two-tier health care or privatization, it is about recalibrating the balance of power from the health provider to the consumer, so we can start to see some of the positive outcomes that our friends across the pond are enjoying.

The comments section is closed.

  • Rees Moerman says:

    It is high time for some real innovation in Canadians adopting implementable as well as practical improvements for sustainable universal health-care. This paper is a ‘breath of fresh air’ in our otherwise moribund and profoundly decaying business-as-usual attitude. Unfortunately this approach persists and typifies so much of our institutional way of thinking. Thanks Dr, Snowdon for uncovering and championing these great ideas. Hopefully some your insightful ‘policy sparks’ will let fly and get the ‘bonfires of change’ started in our fraying health care system. By advocating for far more personal and responsible self-management of our individual health care portfolios we will all benefit. Then we really will have an effective ownership society with far better health equity for all Canadians.

  • Charles E. Durant says:

    I am a healthcare executive in Austin, Texas and my system provides significant levels of care to uninsured and underinsured people and we are redesigning care delivery with emphasis on care coordination and patient outcomes in the outpatient clinic setting. So we know that the poor and vulnerable populations are a particularly challenging segment of our population. With that background, my reaction to the article is one of high level of interest for at least two reasons: Germany and other social insurance programs make a lot of intuitive sense to keep consumer choice and competition in play to help manage overall costs. The second exciting concept is the DMP center to better manage chronic care and get the quality, outcomes, lower readmissions and cost control we need.

    I’m also interested in learning more about what Canadian Health Ministries will be doing to innovate primary care!

  • Caroline Kalaydjian says:

    A marketing-oriented article advocating for private health care in Canada? At least be upfront & clear on your hypothesis and objective, Ms. Snowden.

  • katherine Lembovski says:

    Excellent Thanks Anne for this amazing piece. This is exactly what our family is striving for “consumers to drive innovation in our health systems”. Tis is why we are struggling so much as a family as what happened in us was tragic and as consumers of Long Term Care Nursing Care for our beloved family memeber, the system feel short and we are devasted!

    We believe that the Ombudsman of Ontario needs to take a greater role to help Investigate complaints and better assist the residence of Ontario in finding answers. Also this will help with the accountability to consumers as well.
    Our Dear Grandmother, mother and wife of 60 years RISTOSIJA LEMBOVSKI August 14 2011 “Drown in the Detroit River” while in the “Trusted care” of Rose Garden Villa Nursing Home. She was 83 had Dementia and pushed her walker 3 kilometers to her unfortunate drowning death alone. The Revera owned Nursing Home failed to supervisor patient care and with staff cut backs and many months of Non compliance Violations by the Ministry of Health and Long Term Care Compliance and Regulations branch they were Ordered Non Compliant. The Home never notified the family and had no idea that she was even missing indicating to her husband’s pleas for help that she was just in the bathroom.
    With months of Complaints to the Minister of Health and several govt agencies, A complaint to the Ombudsman’s Office produced no answers as they had no Investigative authority.
    Our family remains haunted by the need to answers of Why this happened and still have not received an acknowledgement by Revera a 7 Billion dollar company controlling the Windsor Long Term Care Market. Our family has Championed behind the Bill C-122 and obtained 1,000 of signatures and supporters.

    Our family wants answers and we are reaching out to the public for help. Any one can contact us to help offer advice or information.
    God Bless Katherine Lembovski (561) 703 6903


Anne Snowdon


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