Where Romanow Went Wrong: Putting Health Care Ahead of Health

K.V. Nagarajan is a professor of economics at Laurentian University.

Dr. Sutherland has had a long career as a physician, administrator, and
academic. This self-published book contains his diagnosis of the
problems besetting Canada’s health-care system and his prescriptions
for revamping the system. Ignoring the difference between health and
health care has led to wrong priorities and spending patterns,
Sutherland believes. Whereas the health of Canadians should be a
priority, the bulk of the spending goes toward health care after they
get sick. The author recommends a population health approach with an
emphasis on prevention and improving the socioeconomic and environmental
conditions. He firmly rejects the current physician-hospital funding
system: “[P]roviding endless no-cost access to hospitals and
physicians is not the best way to spend public money.”

Sutherland advocates a complete overhaul of the system by transfer of
powers and scope of practice. While the federal government would remain
in charge of population health, the provinces would deal with the
details of health-care spending and allocation. Sutherland’s plan
would give the provinces maximum flexibility, which would include trying
everything from user fees to a complete parallel private system of care.
In short, all decisions would be based on evidence and
cost-effectiveness.

The strength of Where Romanow Went Wrong is that it avoids ideological
blinders and raises fundamental questions about every assumption about
health and health care that has been made by actors in the health field.
The book’s main weakness is that, while it catalogues the needed
changes, it says little about how to implement them in the real world.