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Apr 3, 2024
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More for Less: Examining the Trend of Increasing the Quality of Healthcare Outcomes
While Spending Less
Victoria B. Sparkes
Faculty of Health Disciplines, Athabasca University
MHST/NURS 609: Trends and Issues
Dr. Kathryn Crooks
July 5, 2023
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According to the global report published by the World Health Organization “health
spending is growing faster than the overall economy globally” (Xu et al, 2018, p.3). Sadly,
Canada’s health spending is no exception. Moreover, with a rapidly aging demographic,
Canada’s health care needs are only predicted to grow. All of this begs the question: how can
we improve health care outcomes while spending less? In this paper I will examine the
emergence of the trend, demanding increased quality of health care outcomes while reducing
health care spending. Additionally, I will provide future predictions, analyze the available data,
and pose three discussion questions relating to this trend.
The Trend and How it Emerged
A trend is defined by the Encyclopedia Britannica (n.d.) as “a general direction of
change” (section 1). The trend of demanding increased health care outcomes with shrinking
health care costs is one born of necessity; therefore, it can best be understood by examining its
precipitating conditions.
Health Care Spending
As previously mentioned, health care spending is growing exponentially around the
globe, including here in Canada (Xu et al, 2018). As a matter of fact when the Organisation for
Economic Co-operation and Development ([OECD], 2023) examined healthcare spending
among 46 countries, they found Canada to be the 7th largest spender; spending 11.7% of the
country's gross domestic product on health care in 2022. The universal healthcare system in
Canada is funded by both the federal and the provincial/territorial governments (The
Commonwealth Fund, 2020). Federal funding is administered via the Canada Health Transfer,
and is given to each province/territory who meets the stipulations set forth in the Canada Health
Act (The Commonwealth Fund, 2020). These funds account for approximately 24% of overall
provincial/territorial health spending (The Commonwealth Fund, 2020). Meanwhile,
provinces/territories are responsible to pay for the remaining 76%, a feat often acomplished
through taxation (The Commonwealth Fund, 2020). However, Deloitte (2022) forecasts that
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provinces/territories will be unable to meet the growing fiscal demands as health care spending
will “increase at a faster pace than provincial revenues” (p. 23).
Health Outcomes
Why exactly is Canada’s health care spending so high? The reality is, despite the high
price tag, Canadians are not overly healthy. In 2021, the Commonwealth Fund ranked Canadian
health care outcomes tenth among eleven developed countries (Schneider et al., 2021).
Although the number of newly diagnosed chronic conditions is declining, 33.7% of Canadian
adults suffer from cancer, cardiovascular disease, diabetes, chronic respiratory disease, and/or
mental illness (Branchard et al., 2018). Annually these conditions cost the health care system in
excess of eighty-billion dollars (Liu et al., 2020). Moreover, while one in every three Canadian’s
is already living with a chronic illness, 85% of the country’s adults live in risk of developing a
chronic health condition; reporting poor dietary habits, leading sedentary lifestyles, and
consuming too much alcohol (Branchard et al., 2018).
The Trend
Much like the rest of the world, Canada cannot sustain such high health care spending –
especially considering the current health status of the population (Deloitte, 2022). Furthermore,
with an aging demographic, the country is unlikely to see an alleviation in health care needs
(Deloitte, 2022). As necessity is the mother of invention, the trend of demanding improved
healthcare outcomes while shrinking health care spending has emerged. New frameworks and
interventions are rooted in efficiency; aiming to achieve more with less. An example of this, is
the Institute for Healthcare Improvement’s (IHI’s) Triple Aim framework. Published in 2008 by
Donald Berwick and fellow IHI associates, the Triple Aim is a framework directed at improving
patient’s health and their experience within the healthcare system, all while reducing costs. This
globally adopted framework views its goals as interdependent, only obtainable by striking a
delicate balance among all three (Berwick et al., 2008). While authors Bodenheimer and Sinsky
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(2014) have proposed a fourth aim, the basis of the triple aim framework remains the epitome of
demanding better health care outcomes while reducing cost.
Future Predictions
Looking to the future, it is unlikely the trend of demanding better health care outcomes
while decreasing health care spending is going to change. As previously mentioned, Canada’s
population is aging rapidly, and with this comes increased health care costs (Deloitte, 2022).
Likewise, as per Branchard et al. (2018), new and improved treatments see those with chronic
conditions “living longer with their disease”(p. 385). As a result of this, Deloitte (2022) predicts
Canada’s health care spending to reach approximately $409 billion dollars by 2036. Therefore,
the trend of demanding better health care outcomes while shrinking health care spending is
likely to continue – in Canada, at the very least.
The Data
Although I was unable to pinpoint exactly when this trend emerged, federal government
publications cite efforts to reduce health spending prior to 1993 (Government of Canada, 1993)
.
Based on this, I did avail of some older resources pertaining to theory, such as Berwick et al.’s
(2008) Triple Aim. Despite being more than 15 years old, theoretical resources like the Triple
Aim remain a relevant example of this trend today. However, all the empirical data referenced in
this paper was published within the last five years to ensure currency when speaking to the
present and future of the trend. Likewise, as a means of ensuring validity, any sources not
obtained from scholarly journals were gathered from reputable, professional organizations.
Conclusion
Health care spending simply cannot continue at its current rate; however, health care
demands show no sign of slowing. In the face of this dilemma, health care is aiming to do more
with less; demanding interventions that increase the quality of health care outcomes while
shrinking health care spending. In this paper I provided an overview of the trend, as well its
precipitating conditions, discussed future predictions, and analyzed available data related to the
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trend. Furthermore, I have prepared three discussion questions –which can be found in the
appendix— pertaining to the trend of demanding increased quality of health care outcomes
while reducing health care spending.
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References
Berwick, D. M., Nolan, T. W., & Whittington, J. (2008, January 1). The Triple Aim: Care, Health,
And Cost.
Health Affairs, 27
(3), 759–769.
Bodenheimer, T., & Sinsky, C. (2014). From triple to quadruple aim: Care of the patient requires
care of the provider.
The Annals of Family Medicine
,
12
(6), 573–576. https://doi.org/10.
1370/afm.1713
Branchard, B., Deb-Rinker, P., Dubois, A., Lapointe, P., O'Donnell, S., Pelletier, L., & Williams,
G. (2018). At-a-glance - How Healthy are Canadians? A brief update. Aperçu - Quel est
l’état de santé des Canadiens? Brève mise à jour.
Health promotion and chronic disease
prevention in Canada : research, policy and practice
,
38
(10), 385–387.
https://doi.org/10.24095/hpcdp.38.10.05
The Commonwealth Fund. (2020, December). International Profiles of Health Care Systems,
2020 Edition. New York.
Deloitte. (2022, September 23). Measures to Address Health System Challenges – Review of
Canadian, Provincial, and Territorial 2022 Budgets. Ottawa; Canadian Medical
Association .
Encyclopædia Britannica Inc. (n.d.).
Trend Definition & Meaning
. The Britannica Dictionary.
https://www.britannica.com/dictionary/trend
Government of Canada. (1993).
The Health Care System In Canada: Effectiveness and
Efficiency.
Retrieved from the Library of Parliament website: https://publications
.gc.ca/Collection-R/LoPBdP/BP/bp350-e.htm.
Liu, S., Munasinghe, L. L., Ohinmaa, A., & Veugelers, P. J. (2020). Added, free and total sugar
content and consumption of foods and beverages in Canada.
Health Reports, 31
(10),
14-24.
Organisation for Economic Co-operation and Development. (2023). Health Spending.
https://data.oecd.org/healthres/health-spending.htm
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Schneider, E. C., Shah, A., Doty, M. M., Tikkanen, R., Fields, K., & Williams II, R. D. (2021,
August 4).
Mirror, mirror 2021: Reflecting poorly
. The Commonwealth Fund.
https://www.commonwealthfund.org/publications/fund-reports/2021/aug/mirror-mirror-202
1-reflecting-poorly
Xu, K., Siroka, A., Cherilova, V., Indikadahena, C., Roubal, T., Flores, G., Barroy, H., Li, D.,
Garcia, M. A., Touré, H., Maele, N. V., Brindley, C., Kutzin, J., & Soucat, A. (2018). Public
Spending on Health: A Closer Look at Global Trends. Geneva; World Health
Organization.
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Appendix
1.
Have you encountered any frameworks, like the IHI’s Triple Aim, that are rooted in the
trend of demanding improved health care outcomes while reducing health care
spending? If so, what were they?
2.
In the aforementioned review of health care spending, OECD (2023) found the United
Kingdom spent $826 US dollars per capita less on health care than Canada. Yet, unlike
Canada, the Commonwealth Fund ranked the United Kingdom’s health care system
performance fourth among eleven developed countries. Why might this be?
3.
Chronic conditions such as cancer, cardiovascular disease, diabetes, chronic respiratory
disease, and/or mental illness cost Canada’s health care an excess of eighty-billion
dollars (Liu et al., 2020). As indicated by authors Branchard et al. (2018), 85% of
Canadian adults risk developing a chronic health condition as a result of poor dietary
habits, leading sedentary lifestyles, and consuming too much alcohol. Can you provide
examples within the trend of demanding improved health care outcomes while reducing
health care spending, aimed at targeting these risk factors?