June 11, 2001
More Information, More Choices In Swedish Healthcare
The government of Manitoba is rapidly discovering that the solution to the health-care mess is an elusive creature. Unfortunately they are ignoring a conceptual tool that lies right under their noses.
For more than two centuries, in most of the western world, markets have proven their value repeatedly. They have created a consumer-based bonanza, with rising levels of wealth widely shared across the demographic scale.
The essential ingredients of a successful market are not complicated. They include the ability to choose between more than one supplier and the availability of enough information to make an informed choice. Applying these principles to the health-care industry is no great leap, as they have recently discovered in Stockholm, Sweden where a smorgasbörd of competing public and private clinics provide health services within a publicly funded framework. Over recent years, that metropolis shrank waiting lists, lowered costs and improved the quality of medical services by opening up its provider monopoly. It is now taking the next step, improving the healthcare marketplace by expanding the information base for health-care consumers. With a click of a button on the Internet citizens can compare waiting list times for procedures at public and private clinics and choose the facility that works best for them.
As detailed in the Frontier Centre's latest newsletter on Sweden's healthcare reforms, the plan is simply called the Guide to Health Care. It makes good use of the fact that Scandinavians, like Canadians and other peoples with extreme climates, share a high rate of Internet access. When fully operational, the Guide will allow health-care providers to treat their patients on-line.
The Greater Council of Stockholm already posts a great deal of health information electronically. If you have an urgent medical need, you can shop around to discover which facility is able to treat you the fastest. But until recently, the data on availability and waiting times has been hard to find and difficult to understand. Swedes are learning that widely available information on the health care market is a critical component that gives individuals the power to make active choices. If your neighbourhood clinic is unable to provide a service quickly, you can find out who will and arrange to get there.
From this autumn on, Swedes for the first time will need only one portal to survey the whole range of health care services. It will provide a view of all units and producers, conditions for treatment, ways to get in contact with clinics and local doctors, advice on services and inquiries.
"The big step comes in phase two," explains Dagmar Fornander, the project's manager. "From next year on, we will focus on communication. Gradually expanding the system citizens will be allowed to build individual channels for dialogue. Depending on your needs, you will have access to relevant knowledge and communications facilities."
Using a variety of tools -- a personal computer, or even a cell phone -- consumers will be able to subscribe to the kind of information they want. It might take the form of a monthly electronic newsletter, weekly medical advice, a symptoms guide or updated news on waiting times for a range of treatments. The service will contain a revolutionary aspect, the opportunity to ask your doctor questions on line and a requirement that he or she answer you within 24 hours.
Within the framework of the Guide, patients will be able to create their own individualized entry page to the portal, distinguishing the needs, for example, of allergic patients from those suffering from heart problems, as well as those of parents with small children from overweight patients.
Another new service will be electronic matrixes for patient documentation where the patient gives preparatory information about weight, health conditions, the use of pharmaceuticals and medical history. This will reduce the paperwork burden of providers and allow more time during patient visits for doctors or nurses to focus on diagnosis and treatment. This personal documentation will be strongly guarded; every patient will have password protection.
The opportunity to compare all contracted service providers, both public and private, from the Guide's quality ranking will pressure the contractors to improve their level of service. In fact, some doctors object to this expansion of the Guide as a forced march to accountability. A patient needing a hip replacement may decide to hop the train to Stockholm where the waiting time is only six weeks, instead of the 104 weeks common in other cities.
Contrast that progressive step with the cramped mindset in Manitoba, where long waiting times are the norm. Through Bill 25, the Doer Government will forbid Dr. Mark Godley's ultra-modern surgical clinic from allowing customers to stay overnight. Facility fees and third-party payments will be forbidden as well. Meanwhile, successful alternative providers like the Pan-Am Sports Clinic are swallowed up into the poorly functioning monopoly we call Medicare.
Is it the proper role of government to limit choice and regulate all providers so extensively that they can't excel? Or should it expand the range of services and the availability of information about them? Is a publicly funded competitive marketplace that rewards all stakeholders for effective service better than a bloated, bureaucratic monopoly?
The Swedes are going down the path of more information and competition. Expanding the health-care market makes more sense than constantly expanding an expensive system with no market and inferior performance. Manitoba needs more clinics, more information, more incentives to serve consumers.
The Frontier Centre for Public Policy
is an independent public policy think tank whose mission is "to broaden the debate on our future through public policy research and education and to explore positive changes within our public institutions that support economic growth and opportunity."