The Canadian Academic Health Mafia

Lead Consultant:

Tim Lynch

tim@infolynk.ca

Publications:

Health insurance - don't leave home without it
ITIJ Journal Spring 2002

Primary Care Reform in Ontario: The Emperor Has No Clothes
www.hospitalquarterly.com

Medicare in a modern world
The Vancouver Sun, March 14 2002

American / Canadian relations, post September 11th: accommodation or surrender?
ITIJ Journal
Nov/Dec 2001

Choice in health care
The Globe & Mail
Nov. 12 2001

London, UK Travel Insurance Conference Regulations of Canadian Travel Industry
May 2001

Vancouver Hosts Insurance Summit, Report on meeting of the International Insurance Society 2000 seminar, Vancouver B.C.,

DEBATING THE DATA: Is there an entrepreneurial option to primary-care reform? Medical Post
-May 4, 1999-

HEALTH CARE DELIVERY: Rewarding excellence is the solution
Medical Post
-February 9, 1999-

A Book Review: The Billion Dollar Molecule,
Toronto Biotechnology Initiative, (TBI) Bioscan, June 1998

Services / Health Care

The Canadian Academic Health Mafia

In an article about Mr. Romanow's $15 Million Commission in the Times Colonist, December 23 2002, James Cutt, Professor Emeritus of Public Administration University of Victoria, concluded that Romanow paid "the same old academic gang who have been taking in each other's laundry on a demonstrable failed idea for 30 years. This is the same gang by the way, who brought you the elegant tool of budget limits - remember rationing by waiting lists. "

The sentiment expressed by professor Cutt was prophesied by health economist Dr. Peter Ruderman, who, in the mid 70s, made the comment that - health care in Canada is becoming a form of "intellectual masturbation." It was difficult to understand the meaning behind this comment at the time. Over the years observation has shown that Canadian health care academics really do receive a great deal of self-satisfaction from thinking about "health" which comes to a climax with the publication of their "ideas,' but few actually do it.

Presenting themselves as the "honest broker," relative to "for-profit" interests, academics have secured a status approaching omnipotence in Canadian health. There is nothing closer to God for defining "truth" in Canadian health than a committee Chaired by a professor in health administration or better still a (live or retired) Dean of Medicine.

There is an element of justification in the "honest broker" argument. Given the political nature of most health decisions, objective review is critical. But the mythology that representatives of not-for-profit universities are the best qualified to provide counsel on health has to be challenged.

In his book Economics & the public purpose, John Kenneth Galbraith uses the term "symbiotic bureaucracy" to describe the relationship between private sector entities such as the armament industries and public institutions like the Pentagon. A similar relationship has evolved to varying degrees over the past thirty years between academics and health ministry officials in Canada.

The involvement of academics to the decision-making process provides a most valuable service to health ministry officials. Academics provide the appearance of neutrality and "qualified" opinion. The academic process with its literature reviews, hypothesis testing, methodology design and degrees of significance, integrated with bureaucratic committee protocols creates the impression that "something is happening," and it provides the perfect justification for delaying the making of a decision. Many Canadians suffer as a consequence of these deliberations.

A qualified working committee structure is a critical part of policy formulation in a single payer health system. But such structures can be manipulated by the central funding agency. Beyond the preservation of "elitism" there is no justification for the exclusion of private sector representation in this process. In the absence of any market discipline there is often conspiracy that can lead to chaos in the delivery of modern-day patient care.

The above rationale suggests that the pendulum has swung too far in the direction of "academic exercise" over "business rationale." Mr. Romanow failed to adjust this imbalance and design a system that accommodates the expectations of Canadian consumers (8) and exploits all of Canadian enterprise (7).

Info-Lynk Consulting Inc.,