HEALTHY AGING
Canadians who want to remain healthy as they age often can’t get access to advanced treatments developed through Canadian research. istock.com
Need for health-care system transformation to allow innovative treatments to benefit Canadians
While all levels of government recognize the importance of optimizing the health of older Canadians, a number of systemic barriers are undermining efforts to achieve that goal. A key problem is that Canada’s health-care system doesn’t have the demand-side innovation policies required to allow it to easily incorporate new medical technologies and advanced treatments into patient care, says Neil Fraser, president of Medtronic Canada.
“Medical technology advances have the potential to help transform health-care delivery by keeping more older Canadians out of hospital and allowing them to stay in good health at home,” says Fraser. He also notes that healthy aging is supported by preventing, managing and, where possible, treating the chronic conditions that are more common in older Canadians.
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Canadians share the same fundamental objectives – improve patient outcomes and reduce health-care costs. We can reach those goals with a collective effort to dismantle the structural barriers.”
“Even though we know what steps will allow more innovation in care, powerful forces within the system are resistant to change because our current policies create a disincentive to change.”
Canadians like to believe their health care is among the best in the world, but recent international rankings show other nations surpass aspects of our performance. In 2017, The Commonwealth Fund ranked Canada’s health-care system ninth out of 11 developed nations based on measures of access, equity, efficiency and health outcomes.1
The equation for bringing innovation to health care has two sides: supply and demand. The Canadian supply of innovative treatments has been strong, says Melicent Lavers-Sailly, senior manager of stakeholder engagement & strategy for Medtronic Canada. “Canadian researchers have developed many significant innovations in part because governments have focused on funding research talent and innovative research projects.
“Where we fall short is on the demand side. Canadians who want to age in a healthy way often can’t get access to breakthrough Canadian technologies. Instead, they read about these advances getting adopted in the United States and European countries.”
One example is transcatheter aortic valve replacement (TAVR) to treat people with aortic stenosis – a narrowing of the aortic valve opening. The procedure got a lot of attention when it was performed on Mick Jagger earlier this year. The risk of the condition increases with age and, if untreated, it can lead to heart failure. With TAVR, a replacement heart valve is threaded into position through a major artery on a wire (catheter), and recovery time is days rather than the weeks involved in open heart surgery, if there are no post-surgery complications.
“Canadians who want to age in a healthy way often can’t get access to breakthrough Canadian technologies. ”
“Canadians participated in TAVR research, and it’s been available for 10 years,” says Fraser. “But unlike in the U.S. and other countries, in Canada, various complex factors have limited access.”
“Given the choice between open heart surgery and an appropriate minimally invasive procedure, most people would choose the latter,” says Lavers-Sailly. “The key is funding; although funding has increased somewhat, it needs to increase several fold.”
Funding is one category of solutions to the innovation impasse, put forward in a recently published position paper authored by Fraser and Lavers-Sailly (longwoods.com).
The other two areas where reform is needed are in procurement and reimbursement policies. In a fee-for-service reimbursement model, the number of services provided is compensated, rather than improvements to patients’ health.
Ineffective hospital procurement policies are another weakness in the system, Fraser says, with purchases mainly based on the lowest up-front prices for medical products and services.
Other nations have implemented value-based procurement policies that provide strong models for Canada, he says. “Other countries are getting more advanced and effective treatments into their systems because of procurement reform. Denmark, for example, is developing a next-generation model that considers three sources of value: improved productivity, reduced consumption of other health-care services and improved patient outcomes.
“Canadians share the same fundamental objectives – improve patient outcomes and reduce health-care costs. We can reach those goals with a collective effort to dismantle the structural barriers. With a commitment to change, we can help make healthy aging a reality for more Canadians.”
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