Canada spends much more for similar health care results, UK dean says
CMAJ 1998;11:1348
© 1998 Charlotte Gray
Dr. Peter Bundred, the recently appointed dean of health sciences at Liverpool University, says Canada outspends the UK when it comes to health care but has little to show for the extra money. Bundred made the comments during a recent seminar on primary health care reform at the University of Ottawa's Health Sciences Centre. "How come someone from a health care system judged by the American literature as the crappiest in the world has been invited to come and talk about that system in Canada?" he asked with a rhetorical flourish. The answer, apparently, is that Bundred has thought his way through one of the most difficult challenges facing health care providers: how to deinstitutionalize health care while reconceptualizing an Industrial Age model for the Information Age in which we now live.
With the Industrial Age model, he explained, resources and respect are accorded to tertiary, secondary and primary medical care, while the whole area of informal health care is ignored. However, no developed country can afford to continue in this direction, since it is rapidly becoming too expensive and it does not solve problems related to population health. Bundred noted that Canada spends 2.7% more of its gross domestic product on health care than the UK, yet it is not clear what added value it is getting for the extra money. Indicators such as infant mortality and life expectancy are the same on both sides of the Atlantic.
In an Information Age model, Bundred continued, the "triangle of health care" is inverted. The apex of the system — tertiary, secondary and primary medical care — receives fewer resources and less encouragement, while services and networks outside the formal medical system get boosted. In this sea of "informal" contacts Bundred included individual self-care, friends and family networks, self-help groups and complementary medicine. "We must discourage spending on hi-tech hospital care, which is often poorly researched, and encourage people to think of health care professionals as facilitators and partners."
Bundred also provided a vivid example of the cost pressures created by new technology and new drugs. As district officer of health in the Wirral, an area near Liverpool with a population of 360 000, he did a cost-benefit analysis of Viagra, which has not yet been released in the UK. If each man in the area who had talked about erectile dysfunction with his GP was prescribed 4 Viagra tablets a month, said Bundred, it would cost the Wirral region alone £500 000, or $1.2 million, annually. But the Wirral budget is already stretched to the limit, with no increases in sight. This leads to one of the major questions facing publicly funded health care. How can administrators decide whether they can afford to accept new technologies and drugs?
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