Creating high-performing, efficient health care systems

Every second Thursday, we will be featuring an Ontario Research Chair (ORC) from one of the province’s universities. ORCs are university research professorships created to drive provincial research and develop excellence, to create world-class centres of research, and to enhance Ontario’s competitiveness in Canada’s knowledge-based economy. See previous profiles here. 

When the Norwegian government wanted to know the most effective way to run its rural hospitals it went looking for examples of what worked and what didn’t in other countries.

For five days last winter, University of Toronto health policy expert Gregory Marchildon dropped everything to put together a report on Canada’s experience. Along with health policy researchers from seven other countries, he quickly gave Norway what it needed: a succinct analysis of how various countries ensure people in remote areas get access to hospital care.

Marchildon and the others are part of a research network called the European Observatory on Health Systems and Policies. It is designed to collect, analyze and disseminate information on health care policies and reforms. Part of the network’s mandate is to quickly respond to government requests for research on health policy, often by comparing approaches from different jurisdictions.

“Academics usually follow their curiosity and have little impetus to make policy relevant or to respond to government needs in a timely way,” says Marchildon. “But in this case, the Norwegian government is member of the observatory and has a right to expect a timely, policy-relevant response.”

Marchildon is the Ontario Research Chair in Health Policy and System Design, funded by an endowment from the government of Ontario. During his time as chair, he aims to launch a home grown version of the European network—the North American Observatory on Health Systems and Policies (NAO).

The observatory, housed at the University of Toronto, will begin operations this year with several dozen health policy researchers from Canada and the United States, and will eventually expand into Mexico. Its member researchers will analyze health systems across provinces and states and present their findings in a way that helps governments make the best decisions possible for keeping their populations healthy.

From cabinet secretary to academic

Having worked in government and academia, Marchildon is well-positioned to take on building the network. In the late 1990s, he was Saskatchewan’s cabinet secretary and deputy minister to the premier, advising cabinet on the establishment of a commission on medicare. Marchildon went on to become the executive director of Ottawa’s Royal Commission on the Future of Health Care in Canada, also known as the Romanow Commission.

As an academic, he has delved deeply into the history of universal health care in Canada and how our policies stack up to those in other countries. In fact, Marchildon’s 2014 analysis of Ottawa’s policy for transferring tax dollars to the provinces for health care caused a stir among provincial health ministers.

He and his co-author made a simple, but compelling argument: Ottawa should take into account the age of a province’s population and the number of residents living in remote areas when calculating how much money to transfer to provincial health coffers. Currently, Ottawa transfers money on a straight per capita basis, without regard to the extra cost of caring for elderly people and those living outside urban centres.

“We certainly started a conversation,” says Marchildon. “It hasn’t produced a change in policy but it’s on everybody’s radar now and I think the problem will get addressed eventually.”

One of the first projects he expects to take on as NAO’s founding director is an analysis of policies for improving the quality of life of people with dementia and other complex medical needs and their caregivers, all while reducing costs to the public purse. His team has recruited academics and decision-makers from Ontario, British Columbia, Newfoundland and Labrador, Vermont and New York to help sift out the best policies.

“These are the highest cost patients in the system,” says Marchildon. “They are constantly in the hospital and move back and forth to long-term care facilities or home caregivers. We have to find some way to help them and their families.”

He believes the best way to do this is to provide governments with rigorous—and independent—analyses of health policies that affect those with dementia.

While governments do sometimes contract with academics to analyze policy, it’s on a piecemeal basis. Marchildon’s goal is to create a deep well of expertise in a broad range of North American health policies—one that is around for the long haul.

He says this kind of network is especially important in a federation such as Canada, with its central government, 10 provinces and three territories, each with different approaches to delivering health care.

“We talk about learning from this and other federal systems, but we have no vehicle for it,” says Marchildon. “I want the NAO to be a more permanent structure that will facilitate this work for national and provincial and state jurisdictions across North America.”

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