Summarize It!

Note: This is probably of interest to no one except me, as it’s just a summary of the key things – or at least interesting things – I learned from the conference I was at this week, along with some random thoughts I had and connections I made to other things that I’m doing. Rather than reading this, might I suggest you check out my Hockey Hotties instead?

• Two health ministers (current health minister for Alberta & former health minister for Quebec) talked about the social determinants of health! Music to the ears of this Public Health professional! Moreover, the former health minister from Quebec, who is a neurosurgeon, said that after being a minister of health, he felt like he “should have gone into Public Health”!
• In Alberta, about 40% of visits of primary care practitioners are for mental health.
• Physicians should be compensated for using evidence-based practices (rather than paying for specific activities regardless of if that activity is appropriate for a given patient) and we should stop paying them to do things we don’t want them to do. This made me think about how we are learning in Organizational Behaviour/Human Resources (OBHR) at school about how businesses often don’t align their incentives with what they actually want to achieve.
• It’s difficult to stop paying for something we’ve been paying for – which made me think of OBHR class again – “losses hurt more than gains feel good.”
• Many younger physicians don’t like the fee-for-service model, as it asks them to go against what they are trained to do.
• New techniques I learned about:
  • Multi-Criteria Decision Analysis (MCDA) – Analytic Hierarchy Process (AHP) vs. Constant Sum (Budget Pie)
  • Program Budget & Marginal Analysis (PBMA) – this was discussed so often at the conference, an audience member actually asked “Is there anything to priority setting other than PBMA? PBMA is nice because it’s a rigorous method that you can use to align decisions to the intended strategic direction of the organization, to be transparent about how decisions are made, and to be able to defend decisions that you make. It can also be used to make decisions about allocation of resources other than finances. Most effective proposals for re-investment use evidence to support their proposal and clearly show how re-investment is aligned with the strategic priorities. I see similarities with patient engagement in that this requires you provide all the information – including constraints – needed to make decisions to the people you are engaging, so that they can make suggestions that are feasible and so they can understand why you can’t implement everything they might want. Also, patients/public can be engaged in setting criteria and/or weighting criteria. Also, there seemed to be lots of enthusiasm for PBMA from those who had done it (and they said that those who got involved in it – right down to front-line staff – became convinced of its value after being involved).
• We can view “austerity measures” as an opportunity rather than a crisis.
• Priority setting work is bringing together economists and ethicists, but it might now be time to bring in those with expertise in organizational behaviour, because this requires change management.
• We can bridge silos through shared values – we all want to promote health and well-being after all!
• To do more of some things, we have to do less of something else. This can be doing the same things for less cost (e.g., Lean) or taking resources from one area of care (either ineffective care or care that is less effective than the new proposed thing).
• If you use your limited resources more effectively, you’ll have to make fewer trade offs than you would if you kept using your resources ineffectively.
• Priority setting needs to be a part of the way we do business, not just something we do when we have to make cuts.
• There is no such thing as “the Canadian Health Care System” – it’s a patchwork of provincial systems.
• Though the marginalized/vulnerable population uses more health services than the general population, they “dont’ use as much as they ought to in order to meet their needs” *and* we end up paying a lot of money to “rescue” them (e.g., ER), but we won’t spend a little money to support them/prevent the problems in the first place.
• You can include “equity weightings” for your criteria – giving more weight to those in most need. You could even alter these equity weightings in an “ethical sensitivity analysis” to see how different weightings affect the outcomes.
• WHO CHOICE (who.int/choice) – tools and methods for doing cost-effectiveness work.
• When you combine cost-effectiveness assessment with equity, you care able to see the trade off you are making to achieve a more equitable situation (i.e., is this a prce you are willing to pay for more equity?) –> becomes a matter of judgement.
• “Disinvestments” are seen as cuts and tend to be politically unpopular. (Again, losses hurt more than gains feel good).
• Q methodology.