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Dal internist co‑authors paper for The Lancet on Canada’s health leadership obligations

Posted by Rose Poirier on April 13, 2018 in News

Tommy Douglas would be proud.

He’d likely praise Dalhousie Medical School’s young and accomplished internist, Dr. Ashley P. Miller, one of a select group of authors of a series for UK-based The Lancet analyzing Canada’s health system, its global leadership, and its imperative to evolve.

But Mr. Douglas would almost certainly lament the paper’s premise: Canada needs to up its game with bold, concrete action, especially regarding long elective care waits, inequitable access to services outside Medicare, and poor outcomes for Indigenous Canadians. Without embedded accountability at all levels, Dr. Miller says, these issues threaten to mar our polished international reputation.

The paper inspired commentaries by leaders in Indigenous health and foreign aid, as well as Prime Minister Justin Trudeau and Minister of Indigenous Services, Jane Philpott. Trudeau agreed that, “The challenge now is for this government to walk its talk on global health.”

Dr. Miller, an associate professor in the Department of Medicine at Dalhousie Medical School, joined Philpott for the paper’s launch in Toronto in late February. Her involvement is linked to that of the paper’s lead author, Dr. Danielle Martin (founding Chair of Canadian Doctors for Medicare). The Lancet had approached Dr. Martin who, in turn, asked Dr. Miller and other Canadian colleagues, to co-author the paper with her.

“The unique perspective I brought to the team is my specific training in economics,” Dr. Miller explains. Recently returned from London with a masters in health policy, planning, and financing—a joint program between London’s famed School of Economics and of Hygiene and Tropical Medicine—Dr. Miller was recruited to Dalhousie’s Department of Medicine last September with a mandate to advance health-system reform. “I was able to embed some principles (in the paper) around cost-effectiveness and economic sustainability.”

One of the paper’s lessons that struck Dr. Miller most is the danger of incrementalism: “Medicare and its focus on hospitals and physicians were very much viewed as a first step intended to be built upon over time… but that incremental approach requires a lot of political will and unfortunately in Canada we really haven’t fulfilled that progression.”

She also cites formalized accountability across several roles. “You can’t have health-system reform driven by physicians alone or government alone or the public alone. I hope that this paper is a catalyst for more inclusive health policy formation. Such accountability, along with greater federal-provincial collaboration and meaningful public engagement, is the long-term vision.”

The paper advocates for expanding Medicare’s basket of services with a national pharmacare plan—a move demonstrated to produce net savings to the health system overall. This may become reality as the 2018 federal budget just announced an Advisory Council on the Implementation of National Pharmacare. This seems an appropriate step, considering that the paper intended to inform The Lancet’s international readers about Canadian Medicare’s unique nuances and the lessons it has to offer the world.

Dr. Miller is the first director of outpatient care for the Division of General Internal Medicine at Dalhousie and the Nova Scotia Health Authority, with a focus on improved access to care. She is also the director of a newly re-launched home-based transitional heart failure clinic for frail, end-stage heart failure patients.

Read the paper at thelancet.com/series/Canada.