Better Treatment, Better Care (3) Mejor tratamiento, mejor atención (3) Meilleur traitement, meilleurs soins (3) Лучшее лечение, лучший уход (3) Daha İyi Tedavi, Daha İyi Bakım (3) Краще лікування, кращий догляд (3) 更好的治疗，更好的护理 (3)

been used as a lever by federal governments to put the freeze on any été utilisé comme levier par les gouvernements fédéraux pour geler un

number of policy approaches that provinces might have considered and it's certain nombre d'approches politiques que les provinces auraient pu envisager et c'est

an ongoing threat because the government of the day will define what reasonable une menace continue parce que le gouvernement de l'époque définira ce que signifie un accès

access means even a friendly government in ottawa to raisonnable , même un gouvernement ami dans ottawa à

health care reform tomorrow might be changing four years from now la réforme des soins de santé demain pourrait changer dans quatre ans

and that next government might have a different opinion and sections 18 et que le prochain gouvernement pourrait avoir une opinion différente et que les articles 18

through 21 specifically disallow cost sharing or co-pays and they disallow à 21 interdisent spécifiquement le partage des coûts ou la quote-part et ils interdisent la

extra billing which which is a process we see in countries facturation supplémentaire, ce qui est un processus que nous voyons dans des pays

like australia and france where a physician only gets partially paid by comme l'australie et la france où un médecin n'est que partiellement payé par

the government and individuals are free to top up in certain sectors le gouvernement et les individus sont libres de recharger dans certains secteurs,

i think that's where the real problems in the health act are the rest is less je pense que c'est là que les vrais problèmes dans la loi sur la santé sont que le reste est moins

of a barrier to reform though there are still things we can do to improve on un obstacle à la réforme bien qu'il y ait encore des choses que nous pouvons faire pour améliorer

that that's helpful and here's i guess the real problem is that the provinces cela est utile et voici, je suppose que le vrai problème est que les provinces

have been so effective at asking the federal government to pay an increasing ont été si efficaces pour demander au fédéral gouvernement à payer une part

share towards health transfers that now the penalty of having the federal croissante des transferts de santé que maintenant la pénalité de voir le gouvernement fédéral

government say we're going to withdraw transfers is so high that that also acts dire que nous allons retirer les transferts est si élevée que cela agit également

as a barrier to change i think in the early 2000s or mid-2000s comme un obstacle au changement, je pense au début des années 2000 ou au milieu des années 2000

a couple of us had looked at what the transfers were relative to what the un couple d'entre nous avaient examiné quels étaient les transferts par rapport à ce que seraient les

savings from a cost-sharing program would be based on the rand institute économies d'un programme de partage des coûts sur la base de l' étude du

study from the 1970s which is really the only true trial of how much a Rand Institute des années 1970 qui est vraiment le seul véritable essai de combien un

cost-sharing program can save and it was possible in the early 2000s late 1990s programme de partage des coûts peut économiser et il était possible au début des années 2000 à la fin des années 90

to actually implement reasonable healthcare reform and save enough money de mettre en œuvre une réforme raisonnable des soins de santé et d'économiser suffisamment d'argent pour

that the transfers could be foregone and the province would still be better off que les transferts puissent être abandonnés et que la province s'en porterait toujours mieux,

there is a private shift to patients as well but other policies can further il y a un transfert privé vers les patients alors que nous ll mais d'autres politiques peuvent encore

enhance that benefit but now you're right as those transfers grow it améliorer cet avantage, mais maintenant vous avez raison à mesure que ces transferts augmentent, cela

increases the federal government's hold on the provinces it increases the augmente l'emprise du gouvernement fédéral sur les provinces, cela augmente la

federal government's ability to stall reforms that it finds undesirable for capacité du gouvernement fédéral à bloquer les réformes qu'il juge indésirables pour

whatever political reason none of obviously what we're talking une raison politique quelconque, aucune de ce que nous « parlons

about here is is a sound argument against sensible reform it's a political ici est un argument solide contre la réforme raisonnable, il est un outil politique

tool and it's very much it's very much being used in that matter all right well et il est très bien, il est très utilisé dans cette affaire bien bien

then let's talk about how they've managed to maintain universality in a alors nous allons parler de la façon dont ils ont réussi à maintenir l' universalité dans un

number of high-income countries around the world i think what i always object certain nombre de haut pays à revenu du monde entier, je pense que ce à quoi je m'oppose toujours

to whenever we get into this conversation chaque fois que nous entrons dans cette conversation,

is that everyone says oh well we don't want to be like the united states and c'est que tout le monde dit eh bien, nous ne voulons pas être comme les États-Unis et

there are so many other jurisdictions in the world that we can look to if il y a tellement d'autres juridictions dans le monde vers lesquelles nous pouvons nous tourner si l'

universality is something we want to maintain and keep some of the elements universalité est quelque chose que nous voulons maintenir et conserver certains des éléments

of our system so we're not even going to talk about the united states unless we de notre système, nous n'allons même pas parler des États-Unis à moins que nous ne l'ayons

have unless we're forced to so let's talk about some of these other nations fait, à moins que nous ne soyons forcés de le faire parlons de certaines de ces autres nations

and i i and it's a pretty big list australia sweden switzerland france et ii et c'est une assez longue liste australie suède suisse france

germany netherlands uk new zealand when you've done an analysis of those why why allemagne pays-bas royaume-uni nouvelle-zélande quand vous avez fait une analyse de ceux pourquoi pourquoi

did you choose that grouping of nations in particular give us some idea of the avez-vous choisi ce groupe de nations en particulier donnez-nous une idée de les

similarities that that would allow us to replicate some of the things that they similitudes que cela nous permettrait de reproduire certaines des choses qu'ils

do uh going all the way back right around font euh en remontant tout autour

the roman report in the very early 2000s 2001 we sat down and we decided to just du rapport romain au tout début des années 2000, nous nous sommes assis et nous avons décidé de simplement

create a structure of league tables let's see how all of the countries créer une structure de classements, voyons comment tous les pays

around the developed world stack up who's doing better who's doing worse in du monde développé comparent qui va mieux qui va moins bien en

terms of spending in terms of access to health care availability of services and termes de dépenses en termes d'accès aux soins de santé disponibilité des services et

then in terms of outcomes and a number of nations stood out in this analysis ensuite en termes de résultats et un certain nombre de nations se sont démarquées dans cette analyse

sweden switzerland japan france stood out as being leaders in terms of suède suisse japon france s'est démarqué en tant que leader en termes de résultats en matière de soins de

healthcare outcomes or outcomes from the healthcare process and then we know santé ou de résultats du processus de soins de santé, puis nous savons

there's this other group of countries that have no waiting lists for access to qu'il y a cet autre groupe de pays qui n'a pas de listes d'attente pour l'accès aux soins de

healthcare it's not to say that you're waiting it's more like scheduling a santé cela ne veut pas dire que vous attendez c'est plus comme planifier une

haircut or scheduling an appointment for your car they're busy tuesday you're coupe de cheveux ou prendre un rendez-vous pour votre voiture ils sont occupés mardi vous êtes

busy thursday we'll get to the following wednesday we'll do an mri on monday occupé jeudi nous arriverons au mercredi suivant nous ferons une IRM le lundi

there's no systemic waiting list or queue of people to be treated ahead of il n'y a pas de liste d'attente systémique ou de file d'attente de personnes à traiter avant

you and that's uh austria france the netherlands switzerland germany japan vous et c'est euh autriche france les pays-bas suisse allemagne japon

so this subset of countries we decided to take a little closer look and see donc ce sous-ensemble de pays nous avons décidé de regarder de plus près et de voir

what's really going on what do we find in common in all of these countries and ce qui se passe vraiment dans quoi trouvons-nous commun dans tous ces pays et

it's incredible every one of the developed world's top performing c'est incroyable que chacun des systèmes de santé d'accès universel

universal access healthcare systems has cost sharing for universally accessible les plus performants du monde développé partage les coûts des services accessibles

services care is not free at the point of use for the patient which encourages à tous les soins ne sont pas gratuits au point d'utilisation pour le patient, ce qui encourage

more informed decision making about when and where is best access to health care une prise de décision plus éclairée sur quand et où est le meilleur accès au système de soins de santé

system every one of them has private competition in the delivery of chacun d'entre eux a une concurrence privée dans la prestation de services

universally accessible hospital and surgical services all of them in some hospitaliers et chirurgicaux universellement accessibles tous dans certains

cases like in germany it's actually university hospitals that are being cas comme en allemagne, ce sont en fait les hôpitaux universitaires qui sont

privatized because germany has figured out that when the private sector comes privatisés parce que l'allemagne a compris que lorsque le secteur privé arrive,

in the facilities are being recapitalized or being upgraded and les installations sont recapitalisées ou modernisées et

approved for patients and every last one of these nations every one of them has a approuvées pour les patients et chacun de ces pays a une

safety valve a private alternative to the universally accessible system even soupape de sécurité une alternative privée au système universellement accessible même

in sweden which might be considered a mecca of socialist thought patients are en suède qui pourrait être considérée comme la Mecque de la pensée socialiste les patients ne sont

not constrained to the universal system they're not shackled to a government pas contraints au système universel ils ne sont pas enchaînés à un monopole

monopoly they're free to seek care on their own terms with their own resources gouvernemental ils sont libres de rechercher des soins selon leurs propres conditions avec leur ressources propres

when they feel appropriate to do so and about the population is privately lorsqu'ils le jugent approprié et que la population est assurée par le

insured the access to the private sector is quite low in sweden because the secteur privé l'accès au secteur privé est assez faible en Suède car le

public system is quite good as far as patient perception is concerned but the système public est assez bon en ce qui concerne la perception des patients mais l'

option is always there for them and that is an important option to have let's option est toujours là pour eux et c'est une option importante à avoir

stay with sweden just for a minute so i can understand it because everybody restons avec la Suède juste une minute pour que je puisse la comprendre parce que tout le monde

loves to point to sweden as the model for healthcare socialist system i think aime montrer du doigt la Suède comme modèle de système de santé socialiste, je pense que

is what a lot of people believe it is and yet they've got a lot more c'est ce que beaucoup de gens croient et pourtant ils ont beaucoup plus de

competition and private delivery than we do what was what happened there did they concurrence et de livraison privée que nous ce qui s'est passé là-bas ont-ils

did they take a u-turn or did they just develop differently did they have some fait ils ont fait demi-tour ou se sont-ils simplement développés différemment ont-ils eu un

moment of crisis where they said okay we've got to do things differently or moment de crise où ils ont dit d'accord, nous devons faire les choses différemment ou

was it just incremental change it seems to be incremental change and i était-ce juste un changement progressif il semble être un changement progressif et je

think there's a there's a pragmatism there behind these reforms it's it's a pense qu'il y a un pragmatisme derrière ces réformes c'est c'est un

moment of pause where everyone stops and looks around and goes well this isn't moment de pause où tout le monde s'arrête et regarde autour et va bien cela ne

working so we should try something different fonctionne pas donc nous devrions essayer quelque chose de différent

the cost sharing has been increasing in sweden it's about 20 or 25 dollars to go le partage des coûts a augmenté en suède c'est environ 20 ou 25 dollars pour aller

see a doctor um obviously there are exemptions for low-income populations or voir un médecin euh évidemment il y a des exemptions pour les bas -populations à revenu ou

exemptions for children exemptions for the elderly exemptions for people's exemptions pour les enfants exemptions pour les personnes âgées exemptions pour les

chronic conditions there are limits on on annual spending every year out of maladies chroniques des personnes il y a des limites sur les dépenses annuelles chaque année

pocket to protect people from serious health events and to ensure that the pour protéger les gens contre les événements de santé graves a nd pour s'assurer que le

trade-off when people are seeking health care from a doctor is a trade-off compromis lorsque les gens demandent des soins de santé à un médecin est un compromis

between going out for dinner versus seeing a physician a starbucks versus entre sortir dîner et voir un médecin un Starbucks et

seeing a physician we're not trading off eating versus seeing a physician that is voir un médecin, nous n'échangeons pas manger contre voir un médecin qui est

an inappropriate trade-off to be making the swedes have moved into into un compromis inapproprié à faire les suédois sont passés à la

privatization activity-based funding of hospital care again recognizing that privatisation du financement des soins hospitaliers basé sur les activités reconnaissant à nouveau qu'il

there are there are real benefits to having the private sector involved y a de réels avantages à faire participer le secteur privé de manière

competitively in the delivery of universal accessible services it's in compétitive à la prestation de services accessibles universels c'est à

stockholm the hospital is called saint gorons it's actually run by a private stockholm l'hôpital s'appelle saint gorons il est en fait géré par une société privée

for-profit company traded on the swedish stock exchange called capio à but lucratif cotée à la bourse suédoise appelée capio

and that hospital has revolutionized the patient focus of hospital care and et cet hôpital a révolutionné l'orientation patient des soins hospitaliers et

it's a very competitive hospital that actually helped reduce hospital spending c'est un hôpital très compétitif qui a en fait aidé à réduire les dépenses hospitalières

in sweden or at least enhance the availability of services in sweden en suède ou au moins améliorer la disponibilité des services en suède

alongside a reduction in spending i think that as sweden moved into parallèlement à une réduction des dépenses je pense que lorsque la suède est passée à l'

activity-based funding and st burns was a part of that that changed but activité nding et st burns faisaient partie de cela qui a changé, mais le

activity-based funding takes a lot of the credit here the suites were financement basé sur l'activité prend une grande partie du crédit ici, les suites étaient

available they are able to deliver 11 more health care for one percent less disponibles, elles sont en mesure de fournir 11 soins de santé supplémentaires pour un pour cent d'

money just as a result of the transformative reforms and the parallel argent en moins, simplement en raison des réformes transformatrices et the parallel

sector has always been there in sweden it was never outlawed it was never sector has always been there in sweden it was never outlawed it was never

forbidden that's something that is is across europe it's always exist forbidden that's something that is is across europe it's always exist

i love the way you've worded that so you get 11 i love the way you've worded that so you get 11

more services for one percent less cost relative to the status quo because more services for one percent less cost relative to the status quo because

oftentimes the reason why the private sector is treated with suspicion of oftentimes the reason why the private sector is treated with suspicion of

those who don't want the system to change is oh well they'll just siphon those who don't want the system to change is oh well they'll just siphon

profits off the top and the profits will then uh go into the pockets of profits off the top and the profits will then uh go into the pockets of

shareholders and that's money that could be spent to ex expand services so how do shareholders and that's money that could be spent to ex expand services so how do

you how do you how do you address that issue because there's a real you how do you how do you address that issue because there's a real

reluctance i think to talk about profit being an aspect of such an essential reluctance i think to talk about profit being an aspect of such an essential

service to the the health of our lives i mean i think people maybe it's maybe service to the t he health of our lives i mean i think people maybe it's maybe

uniquely canadian experience that this is one of those areas where you almost uniquely canadian experience that this is one of those areas where you almost

have a pr a national consensus that province should pro profit shouldn't be have a pr a national consensus that province should pro profit shouldn't be

a part of it and so ex make the case for for for profit why shouldn't we be a part of it and so ex make the case for for for profit why shouldn't we be

worried about that i think first there's a misunderstanding worried about that i think first there's a misunderstanding

of where profit comes from profit is not off the top profit is the residual that of where profit comes from profit is not off the top profit is the residual that

remains after services are delivered and profit is a great motivator it is remains after services are delivered and profit is a great motivator it is

what motivates providers to focus on patients to focus on the long term to what motivates providers to focus on patients to focus on the long term to

ensure services delivered efficiently janus coroner pointed to to a ensure services delivered efficiently janus coroner pointed to to a

fundamental difference between government business enterprises and fundamental difference between government business enterprises and

for-profit enterprises this is not just in healthcare this is in any economic for-profit enterprises this is not just in healthcare this is in any economic

sector there are any number of studies supporting this sector there are any number of studies supporting this

the government can deliver services below standard below expectation and the government can deliver services below standard below expectation and

lose money continuously there's nothing to stop them from doing that lose money continuously there's nothing to stop them from doing that

a private operator has a very different set of incentives and structures they a priva te operator has a very different set of incentives and structures they

cannot lose money on an ongoing basis they cannot treat patients poorly cannot lose money on an ongoing basis they cannot treat patients poorly

because those patients will go to another provider especially in an because those patients will go to another provider especially in an

activity-based funded system where money's following patients if you don't activity-based funded system where money's following patients if you don't

look after people appropriately and provide the services they desire they look after people appropriately and provide the services they desire they

won't come to your facility and eventually your facility just closes won't come to your facility and eventually your facility just closes

that's where profit comes in to motivate hospitals to look after people there are that's where profit comes in to motivate hospitals to look after people there are

a number of important constructs that have to be in place but there is no a number of important constructs that have to be in place but there is no

evidence to say that this doesn't lead to a better health care system in fact evidence to say that this doesn't lead to a better health care system in fact

there's an abundance of evidence to say that you do get a better universal there's an abundance of evidence to say that you do get a better universal

access healthcare system universal access healthcare system when you have access healthcare system universal access healthcare system when you have

private competitive provision of medically necessary universally private competitive provision of medically necessary universally

accessible services under an appropriate policy construct money following accessible services under an appropriate policy construct money following

patients is critical we can't be paying hospitals to exist we have to pay them patients is critical we can't be paying hospitals to exist we have to pay them

air for people and we have to have appropriate constructs and impossibles air for people and we have to have appropriate constructs and impossibles

in place to ensure that there's enforcement and an add-on to this that in place to ensure that there's enforcement and an add-on to this that

is incredibly beneficial certainly from from the experience of a number of is incredibly beneficial certainly from from the experience of a number of

countries is reporting of hospital outcomes reporting of adverse events countries is reporting of hospital outcomes reporting of adverse events

reporting hospital report cards effectively for the public not just by reporting hospital report cards effectively for the public not just by

government but also done by the private sector independently like we see in the government but also done by the private sector independently like we see in the

united kingdom and i know we weren't going to talk about them but we do see united kingdom and i know we weren't going to talk about them but we do see

the united states where they are leading on hospital report cards and actually the united states where they are leading on hospital report cards and actually

rank hospitals based on how they're looking after patients and there have rank hospitals based on how they're looking after patients and there have

been meaningful improvements in patient outcomes as a result of that okay well been meaningful improvements in patient outcomes as a result of that okay well

since you mentioned america then i will also mention that not all since you mentioned america then i will also mention that not all