Who’s the Captain?

Here’s the good news: we’re getting older. The bad news is this has created a wicked problem for Canada’s health-care system.

A few years ago, Canada reached a rather sobering milestone: seniors now outnumber children under 14 years old. By 2031, one in four of us will be older than 65.

Here’s the kicker: per-person spending on health care is more than four times higher for seniors than for those aged 15-64. In Alberta alone, we already spend somewhere in the neighbourhood of $22 billion annually ($60 million daily) on health care, out of a $56-billion annual budget. Pair this with revenues from fossil fuels losing their public shimmer and becoming ever more finite, together with Albertans’ acid-reflux response at the notion of a sales tax, and we find ourselves in a perplexing conundrum. Do we tarnish the shining symbol of our national identity by making universal health care less universal and less caring; do we keep feeding the health-care “Leviathan’s” insatiable appetite for more public funds; or do we methodically save our risk-, innovation- and change-averse health-care system?

So let’s talk about this “Leviathan” — better known as Medicare: Canada’s national health insurance program, which is supported by every provincial and territorial health act. It ensures distribution of federal funding to provinces that provide access to medically necessary health services delivered in hospitals or by physicians — but many provinces expand it to encompass home care and long-term care, funded through direct charges to patients. 

Here’s the challenge. In a country with declining health-care budgets, we’ve got a fragmented patchwork of 14 different legislated health acts (13 provincial/territorial, one federal) that fund treatment and some health-care providers at the expense of prevention and other types of health-care providers. The result is a national, politicized and disjointed approach to population health and wellness management, plagued by redundant spending, Machiavellian power struggles, and squandered opportunities for collaborative and scalable innovation.

In other words, our system was not built to last.

Strategy experts would call our health-care challenge a wicked problem, described by strategic management scholar Dr. John Camillus, PhD, as an unprecedented challenge of unknowable root causes involving myriad stakeholders, values and priorities, and a problem that continuously morphs with each attempt to address it. All of a sudden, “Leviathan” becomes “Hydra.”

Yet, this epic challenge is a defining opportunity for UCalgary and our alumni. Innovative solutions to wicked problems are best solved through collaborative research paired with entrepreneuship-driven hypotheses and experimentation. UCalgary, a research and entrepreneurial-driven university, is uniquely suited for this work. It is teeming with experts in public policy, law, business and organizational strategy, health and wellness, information technology, and more; and it has a mandate that embraces both analytical research and entrepreneurial action.

We could start to address this challenge by establishing a coalition of collaborative, action-oriented, cross-sector stakeholders that value solutions that strengthen sustainable universal care. Stakeholders such as public organizations like Alberta Health Services (AHS) and our Primary Care Networks (PCN); large private health information technology vendors like TELUS Health, Epic and DynaLIFEDx; new-entrant social entrepreneurs, supported through organizations such as the Hunter Centre for Entrepreneurship and Innovation at the Haskayne School of Business, Platform Calgary and more; and patient-advocacy groups like Greg’s Wings and Imagine Citizens.  

Then, we could continue this work by creating room for real-world, hypothesis-driven health-care solution experimentation with real people and, over time, replacing the culture of institutionalized risk-avoidance. These efforts, however, are for naught if we neglect the need to commercialize and scale solutions beyond Alberta. A recent University of Toronto paper describes Canada as the land of stranded health-care pilot projects, because our system is largely incapable of bringing any innovative solutions to our largest procurer — the public health-care system. Allocation of even a small percentage of our annual $22-billion health-care budget, supported by better innovation-procurement processes, will significantly impact health-care service productivity and patient outcomes. We need to make this happen.

Wicked problems shape-shift and are rarely solved indefinitely because each new solution changes the relationship of constraints, resources and stakeholders. A continuous system of self-rejuvenation is consequently essential for sustainable universal health care. Wrestling the “Leviathan” into a sustainable state requires Herculean stamina. Nonetheless, the importance, urgency and consequent benefits of success are compelling: an inspirational mission that unifies UCalgary’s 185,000-strong alumni while attracting the globe’s best researchers and research funding; an economy diversified by a health-care business ecosystem that attracts the best social entrepreneurs and investment capital; and the opportunity to significantly reduce health-care spending and heal our universal health-care system while taming an otherwise-overwhelming demographic tsunami.