High Performing Healthcare Systems

Improvements in science, technology and care have offered the promise of better healthcare and improved health. But many healthcare systems have been unable to cope with the acceleration of knowledge growth, thus creating a gap between the care that is possible and the care that is delivered. Many commentators bemoan the inconsistent quality and increasing costs of current healthcare and fear the future burdens posed by aging populations and the costs of adopting emerging therapeutic and diagnostic innovations. Providing consistent, high-quality care is a challenge even in the countries that spend the most on healthcare (Institute of Medicine 2001). The increasing complexity of healthcare systems in industrialized countries has further exacerbated the quality chasm, thereby leading to a healthcare delivery system that is complicated, inefficient and uncoordinated. Improving the safety and quality of care is an increasingly important objective in all health systems. Advances in measurement have helped to highlight variations between organizations, and across regional and national health systems. For example, the Commonwealth Fund, a health foundation based in the United States (US), has sponsored multi-country surveys of patients and physicians for 10 years, releasing the results of these surveys annually.1 The results demonstrate that the US system, which is the most expensive of the seven systems studied, performs poorly in most dimensions compared with other countries (see Table 1). The Canadian system is the most expensive of the non-US systems; however, its performance is the lowest on several dimensions of quality, including the provision of appropriate, coordinated and patient-centred care, and next-to-lowest in most other dimensions (Commonwealth Fund 2007). The Organisation for Economic Co-operation and Development (OECD) recently released a report based on administrative data. It revealed wide variations in performance between Canada and the other OECD countries. For example, in 2005 the 30-day mortality rate from acute myocardial infarction was lower in Canada than the average for OECD countries, while the 30-day stroke case fatality rate was higher (Organisation for Economic Co-operation and Development 2007).