Incentivizing the delivery of sustainable care of chronic diseases in Canada: Case studies in musculoskeletal disease

Concerns about the sustainability of publicly funded health systems and the rising cost of care abound, yet there is little research that explores health care efficiency. Simple cost-saving exercises (i.e. cutting services) may risk harming patients, while more sophisticated, efficiency-saving approaches aim to provide health care at a greater benefit per unit of cost. Encouraging quality and value of health care delivery, whilst reducing waste, is also an indirect way to control health care costs. Undertreatment (failure to use best available care), overtreatment (treatment contrary to best-available evidence or preferences of patients), and poor coordination of care are three key clinical sources of waste. Many large-scale schemes aim to incentivize better health care, but show mixed results.

Dr. Harrison's research will translate aspects of successful schemes and inform sustainable health care provision in Canada, focusing on musculoskeletal (MSK) diseases as they have been central to successful schemes. MSK diseases affect 11 million Canadians, and contribute hugely to the economic burden of disease in Canada. They have extensive impacts on people's lives, including their health-related quality of life, ability to work, financial situation and reliance on the health care system. Additionally, high quality care of rheumatic disease requires early access to treatments which are often complex and considerably different from one another. Therefore, it is increasingly recognized that patients need coordinated, multidisciplinary support and care.

Dr. Harrison's program will encompass policy-focused health economics and outcomes research to inform the design of financial and non-financial incentives to improve the efficiency of health care delivery.