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There's a disconnect between the resources going into healthcare and the services delivered.
We need high-quality, public data to save our health system. Time to fill the gaps.

Healthcare is in crisis.

Everyone's scrambling to make changes.

What if we don't MEASURE the RESULTS of those changes?

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Principles

You can't improve what you don't measure.
It's hard to pin blame when you can't show how bad it is.

Measure the right things.
Leaders frame health decisions as "we're investing $XX million for Y." We measure progress by how much we spend (inputs) and not the services delivered (outputs). Investments can be good or bad; the only way to tell the difference is to track the results.
Tax dollars transferred to the health system is not health care.

Data needs interpretation and public scrutiny.
Data is not information. And health care is complicated. Most people understand only a very small piece. If we're truly interested in fixing our health system, we need to bring together a lot of perspectives and encourage frank debate.
Cherry-picking siloed data is propaganda not information.
Informed decision making, questions, and learning need data.

Incentives drive behaviour.
If we need data to improve, why don't we have it? Because it doesn't look good. And what impact would disclosing those results have on government? It would make them look bad. So what's their incentive to disclose? There isn't one.
Funding, operating, and reporting is a conflict of interest.
Change comes from external pressure not entrenched interests.

Resources are finite.
We need to identify opportunities to do more with less. The answer can't always be more resources. There are tremendous opportunities to improve how productively we use what we already have. Data helps us do that.
Lack of data enables covering up flaws and waste.
Fixing healthcare is a political and management problem.

If you fail to plan, you plan to fail.
Our current approach—throwing money at the problem—will never solve it. We lack goals and targets. Primary care for everyone? What would that look like? What are the steps to get there? What's the timeframe? What are the resources required? How do we get them? What are the intermediate steps? And how do we measure how well the plan is working? Now we announce things, but there's never a real plan to get results. That's not what we expect from a $30 billion health system. Incentives explain why this happens. But it needs to change if we're going to fix anything.
Saying that we're trying our best is not a plan.
SMART goals, detailed steps, and tracking beat media releases.

Fixing health care requires thinking differently.
We need to stop being distracted by worrying about new medical schools, more money, public vs. private, or any narrow solution proposed for a problem. We need to stop focusing on ideas in isolation. We can have an effective public health system and still live within our means. But it means changing how we think. Tracking meaningful results and not just inputs. Planning. Data. Transparency. Accountability.
Ideas and solutions are only good if they achieve real results.

Data drives decisions—or it should

Individual health decisions rely on accurate information—that people don't have. At the same time, health spending is skyrocketing. Services are deteriorating. It doesn't add up. We're not spending wisely. We can do much better.

Better data means more scrutiny and better decisions.
Individually and for our health system.
That's the goal.

BC spends > $30 billion per year on health

Who is responsible for ensuring we're getting the best possible use of it? Nobody.

Transparency and accountability in health care is extremely spotty. There are some things we have amazing information about. Want to know how much any specific doctor bills MSP? No problem. What the $1.2 billion the PHSA allocates to "corporate" expenditures is for? Good luck. Bottom line, we can't see where much of the $30 billion in taxpayer dollars goes.

When we do, often it's not where we think. Health bureaucracy has skyrocketed while private interests are siphoning off staggering sums yet delivering little in the way of services.

The data is out there

The system needs data to improve. And people need data to make individual choices about their own health care. To get it, the political cost of suppressing it has to rise.

As you'll see, a rich amount of useful data is already collected. While most is kept secret, some very useful information is even published (for example, on surgical wait times). They can do it when they want to. Let's motivate them to want to more often.

Data highlights opportunities

To get our health system on track, we need to make more productive use of resources. Data helps identify opportunities for improvement or reallocation. You'll notice I've categorized what appear to be areas of questionable spending or misuse of resources as "opportunities."

When we're upset with the health system, our usual reaction is to point out how badly the present system is working, highlight the flaws, and then...? There's an implicit "now that I've pointed it out, someone should fix it!" (Full disclosure: I'm far more guilty of this than most people.) But how much longer do we keep doing that and see that nothing changes?

Why not? The incentives are all wrong (see box). We need to change those incentives to have any hope of fixing things. So that transparency and accountability benefit our leaders, not punish them, even if what is being disclosed isn't great. It's necessary to move forward.

We need to start thinking not about how badly we're doing, but how to do it better... and nudge everyone in that direction. So let's reward identifying opportunities and acting on them. We're going to make mistakes. We already have. But we can't learn from our mistakes if we bury them.

Our approach to health care must change

We're good at coming up with ideas and throwing money at them. We've been doing that for a long time. And we think the answer is doing even more of it. It's not.

For example, if we want to improve access to primary care, we come up with various ideas, e.g.,

pay doctors more to follow patients
add nurses to take over various routine tasks
provide infrastructure so clinicians can focus entirely on care
reduce the burden of unneeded work, e.g., sick notes
...

Each of these are reasonable. So we then throw a bunch of money at various ones in isolation. So, e.g., we spend $XXX million to build XX UPCCs so that doctors have teams and can focus on clinical care... so this will improve access to primary care.

So what happens next? We build the UPCCs or add nurses and measure our success by how many nurses we added or UPCCs we built. But we don't measure if that actually improved access to primary care. And often, it doesn't. We treat each of these things in isolation, which doesn't work in such a complex system. We miss the big picture. We ignore other parts. We make assumptions that are never validated. It's how we manage the complexity. But it doesn't work. We need to measure real outcomes.

There's no achievable end goal. We're basically saying "this is a step that should help."

There's nothing wrong with that. But it can't be all we do. What would happen if we built buildings that way?

About this Site
Maintained and curated by Mark Roseman. The information herein comes from various sources, including public records, freedom of information requests, and other reliable sources of information. I've collected some of it, but much of it comes from other people who have contributed it.

Contents of this website have been placed in the public domain. Use, reuse, and modify as you see fit, no acknowledgement necessary.

Contributing
If you have information to contribute, please contact me, preferably via email. While I need to know who is contributing what, given the risk of retribution (career, licensing, etc.) for speaking out, I will not attribute any information to you without your explicit permission. I reserve the right to decide what material is published here, based on reliability, relevance, or other factors.

Shouldn't government have a site like this?
Yes. But they won't if it will hurt them.

It's not that they don't have the information. But it's often not in their best interests to make it available. When misspending comes to light, it hurts the government. In our 'gotcha' politics, it's better for them to keep making expensive announcements and not look too closely at the results.

But you can't fix what you don't know is broken. And that $30B is very tempting for anyone to divert for personal gain. Who would know?

There's a disconnect between the resources going into healthcare and the services delivered.We need high-quality, public data to save our health system. Time to fill the gaps.