Before you can argue for an investment, you need to have a full picture of costs and benefits. In a northern health setting, many factors determine both.
We have been building a tool that holds the ledgers together. It works through five questions.
What does standard care actually cost?
For each population segment, with the current care arrangement, the tool builds a baseline — what the system spends on clinical complications, on travel, on outcomes that fall short of where they could be. Each number becomes a piece of the argument once a designed care model gets compared against it.
What changes when we run a designed care model?
Given a defined team and a defined approach, the tool projects what shifts. The model's drivers — visit length, behavioural health presence, community health worker support, follow-up cadence — shift outcomes by a calculated amount. The tool then computes the cost difference between standard care and the designed model.
How much of what we save shows up in life years rather than dollars?
For each complication, the tool tracks QALYs lost and PYLLs incurred alongside the dollar cost. Scenarios report QALYs avoided and PYLLs avoided as line items. The tool produces both dollar-denominated and life-year-denominated outputs in the same run, which lets a Ministry argument and a population health argument be made from the same scenario.
How much of what we save is travel?
The tool keeps travel costs separate from clinical costs throughout. Travel costs accumulate as person-days south, multiplied by an all-in daily cost. The output reports travel days avoided and travel cost avoided as their own line. This matters because southbound travel is one of the most expensive and least visible costs in northern care, and one of the easiest to displace through adequate in-region capacity.
What if we prevent the disease in the first place?
Prevention compounds. A high-risk person who avoids developing a chronic condition saves the system money in every subsequent year, not just the year of prevention. The tool projects this compounding over a ten-year horizon, separating flat management savings from cumulative prevention savings. By year ten, the prevention component is doing more work than the management component in many scenarios.
What this is teaching us
Surfacing these questions gets us closer to a clear case for action, and builds confidence in articulating a delicate balance of objectives. The five questions don't exhaust what the framework can ask. They are the ones this piece of work has surfaced, in a specific setting, on a specific case. Other questions are visible from here: how to integrate workforce sustainability, how to express incommensurable goods alongside dollar and QALY outputs, how to handle uncertainty in scenario modelling, where the framework holds and where it strains.