HEALTH & HEALTH CARE: UNDERSTANDING THE

FUTURE: STARTS WITH THE PATIENT

Honourable Carolyn Bennett M.D., M.P.November 9, 2010

Sustainability of Health Care System

Our cherished health care system will only be sustainable if we redouble our efforts to

keep Canadians well

We must develop integrated systems for health

that are accountable for results for patients

Incentives for QUALITY not QUANTITY

Goal of Medicare…

Sharing risk getting people the health care they need

when they need it

Keeping people well not just patching them up once they get sick

Sir Michael MarmotChair, WHO Commission on Social Determinants of Health

“The worst thing for a physician is to help someone get well and then send them straight back into the situation that made them sick in the first place”

Canadian Institute for Advanced Research

25% attributable to health care system

15% biology and genetics10% physical environment50% social and economic

environments

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Short History of Canadian Health Care System

1947: Saskatchewan’s The Saskatchewan Hospital Services Plan is passed in the Legislature – Hospital universal free coverage.

1957-58: Hospital Insurance and Diagnostic Services Act (HIDS), Provides a 50-50 cost sharing plan to the provinces for everything “hospital”.

1962: Saskatchewan pioneers again with The Saskatchewan Medical Care Insurance Plan Extension of universal, publicly funded insurance to physician services.

1967-68: Medical Care Act – federal legislation providing 50-50 of physician services costs to the provinces.

1976-77: The 50-50 cost-shared arrangements are replaced by a block fund byt theThe Established Programs Financing Act (EPF).

1984: To clarify conditions of federal contributions and keep health care free and universal, Parliament passes unanimously the Canada Health Act (CHA).

Monique Bégin

8

Fundamentals of Canadian health care system since inception in 1957

The Canada Health Act (1984):14 pages

Universality: all Canadians and permanent residents are covered

Accessibility: "free" at point of use (added in 1984)

Comprehensiveness: all medically necessary hospital and doctor services

Portability: between the 10 provincial and 3 territorial systems

Public Administration: each province has a public government agency as its single- payer

Monique Bégin

Empowered Patient

Effective Advocate

Engaged Citizen

Patient as Partner Doctor Multidisciplinary Hospital Community Social Determinants of Health

Health Care or a Real System for Health

Patchwork quilt of non- systems

Focus on sickness…and the repair shops

The Tyranny of the Acute

As long as citizens think of the sickness care system whenever they hear the word ‘health’ we are not going to be able to reorient health systems.

Citizens have to ‘get it’

More health …less health care

Service contract ??????

Or longer warranty ????

Social Determinants of Health

vs

Choose Health(modifiable risks)

THE CAUSES OF THE CAUSES

Versus

The Causes

2005

CAUSES

CAUSES of theCAUSES

Fleeing the Medical Model,Embracing the Medicine Wheel

Public Health 101

1.Do you think we should have a:

A) strong fence at the top of the cliff

B) state of the art fleet of ambulances and paramedics waiting at the bottom ?

2. Would you prefer:

A) Clean air

B) Enough puffers and respirators

for all

3. Would you prefer that wait-times were reduced by:

A) a falls program to reduce preventable hip fractures

B) private orthopaedic hospitals and more surgeons

4.Governments should boast about:

A) how much they spent on the sickness care system

B) the health of their citizens, leaving no-one behind

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The Citizen and the Constitution

The U.S.A.

Life

Liberty

The pursuit of Happiness

Canada

Peace

Order

Good government

Moniqe Bégin

24

OECD 2007 data just released

Physicians per capita: 2.4/1000 pop.

Nurses: 10.6/1000 Acute care beds:

2.7/1000 MRIs: 19.5/1 million

pop. Life expectancy at birth:

78.1 years Infant mortality rate:

6.7/1000 live births Obesity in adults:

34.3%

Physicians per capita: 2.2/1000 pop.

Nurses per capita: 9/1000

Acute care beds: 2.7/1000

MRIs: 6.7/1 million pop. Life expectancy at

birth: 80.7 years Infant mortality rate:

5/1000 live births Obesity in adults: 15%

Monique Bégin

25

U.S.A: Health care =

a market commodity

Medicare and Medicaid

CANADA: Health care =

a universal common good for all citizens of all ages, all conditions

All universities are public and heavily subsidized by both levels of government

Monique Bégin

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Who pays for health care? (2007)

Total HealthExpenditure 2.4 Trillion $160 Billion

Per capita $7,290. $3,895.

% GDP 16.2 10.1

% publicly 45% 70% paid Srs, dis, poor, vets tax, no ext-billing

% privately 55% 30% paid employer/pers insur $ drugs,dent.vis.home

Uninsured/ 47+M universal coverage forUnderinsured 25M doctors and hospitals

U.S. Canada

"Achieving Health Reform's Ultimate Goal: How Successful Health Systems Keep Costs Low and Quality High“ Senate Committee on Aging Sept 30,

2009

1.  INSURANCE COMPANIES: 30% of your costs – almost a third – go to

insurance companies. Your patients and taxpayers have to

support massive organizations. These insurers set premiums, design

packages, assess risk, review claims and decide who to reimburse for how much.

But they don’t deliver health care.  

"Achieving Health Reform's Ultimate Goal: How Successful Health Systems Keep Costs Low and Quality High“ Senate Committee on Aging Sept 30,

2009

 2.  ADMINISTRATION: 

Our single payer system is simpler, allowing us to run the administration of our offices and hospitals with much fewer staff – about 4%.

We don’t have to deal with multiple payers, or chase bad debts.

We don’t have to charge higher fees to compensate for unpaid for procedures  

"Achieving Health Reform's Ultimate Goal: How Successful Health Systems Keep Costs Low and Quality High“ Senate Committee on Aging Sept 30,

2009 

3.  PHARMACEUTICAL PRICE CONTROLS:

Although drug costs are rising in Canada as here, we’re able to exercise more control over the cost of drugs as a result of our Patented Medicine Prices Review Board.  

"Achieving Health Reform's Ultimate Goal: How Successful Health Systems Keep Costs Low and Quality High“ Senate Committee on Aging Sept 30,

2009

4.  MALPRACTICE INSURANCE:

The not-for-profit Canadian Medical Protective Association covers medical malpractice for all Canadian physicians with comparatively low premiums.

Doctors’ remuneration does not have to reflect those extra costs and our justice system has successfully kept the awards in a reasonable range.

"Achieving Health Reform's Ultimate Goal: How Successful Health Systems Keep Costs Low and Quality High“ Senate Committee on Aging Sept 30,

2009

5.  EVIDENCE-BASED CARE:

From vaginal births after C-sections to, lumpectomy, to x-rays for sprained ankles, applying evidence to determine the appropriateness of tests and procedures translates into fewer unnecessary tests and procedures and less defensive medicine.

We are committed to moving from the error of pure cost-containment approach of the early 90s into true evidence-based cost effective care.

 

"Achieving Health Reform's Ultimate Goal: How Successful Health Systems Keep Costs Low and Quality High“ Senate Committee on Aging Sept 30,

2009 6.  PREVENTION:

Diseases are cheaper to treat if they’re caught early, and since all Canadians are insured, they’re more likely to have pap smears, mammograms and other early detection visits and tests, than US patients who are not covered.

 

"Achieving Health Reform's Ultimate Goal: How Successful Health Systems Keep Costs Low and Quality High“

Senate Committee on Aging Sept 30, 2009

 7.  FAMILY MEDICINE: A long-standing speciality in Canada, family doctors are trained to help patients

navigate their care; we interpret the difference between what

patients think they `want`, and what they actually `need` .

A point of first contact, a trusted coach to explain the evidence and the choices.

 

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Issues with Canadian health care

Wait times: the one big complaint. Now addressed with a national plan/special budget.

Adequate supply of physicians and nurses: at long last increasing since 2000.

Capital investment for CTs and MRIs: still lacking. Need for PET scans

Most appropriate care, most appropriate provider (paid & unpaid), most appropriate place.

THE GREY TSUNAMI ?

R.O.M.P.Collingwood

April 24, 2008Dr. Carolyn Bennett M.P.

The Grey Tsunami ?

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What do Canadians think of their system?

OECD study of 10 countries … US least satisfied with the care they receive Canadians 5X more likely to be satisfied with their care

The Nanos Research poll, 12 August 2009: …on the eve of the national convention of the Canadian Medical Association (CMA): shows an overwhelming 86% level of public support for

"public solutions" to improve Canada's national health care system.

The Harris-Decima poll, early June 2009: found 70% of Canadians say the system is working very

or fairly well.

Monique Bégin

Health Goals for Canada

As a nation, we aspire to a Canada in which every

person is as healthy as they can be – physically, mentally, emotionally and spiritually.

Empowered PatientsEffective AdvocatesEngaged Citizens

Use the system wisely

Keeping our families well Clinical guidelines Self Care Manuals

Fight for more HEALTH so we`ll need less health care

Democracy between elections

The Goal Most appropriate care

In the most appropriate place

By the most appropriate person –

paid and unpaid

Federal Government must lead by example

5th biggest provider of health care

Aboriginals Military Veterans Corrections RCMP Public Service

“We are not tinkers, who patch and mend what is broken. We must be watchmen, guardians of the life and health of our generation, so that stronger and more able generations may come after.”

Dr. Elizabeth Blackwell

first woman physician North America