HEALTH & Health Care: understanding the future: Starts with the Patient

1. HEALTH & Health Care: understanding the future: Starts with the Patient Honourable Carolyn Bennett M.D., M.P. November 9, 2010

3. 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

4. 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

5. 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”

6. Canadian Institute for Advanced Research • 25% attributable to health care system • 15% biology and genetics • 10% physical environment • 50% social and economic environments

7. 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 byttheThe 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 sinceinception in 1957 The Canada HealthAct (1984): 14 pages • Universality: all Canadians and permanent residents are covered • Accessibility: "free" at point of use (added in 1984) • Comprehensiveness: all medicallynecessaryhospital and doctor services • Portability: between the 10 provincial and 3 territorial systems • Public Administration: each province has a public governmentagency as its single- payer Monique Bégin

9. Empowered Patient Effective Advocate Engaged Citizen

10. Patient as Partner • Doctor Multidisciplinary • Hospital Community • Social Determinants of Health

11. Patchwork quilt of non- systems Focus on sickness…and the repair shops Health Care or a Real System for Health

12. 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.

13. Citizens have to ‘get it’ • More health …less health care • Service contract ?????? • Or longer warranty ????

14. Social Determinants of HealthvsChoose Health(modifiable risks)

15. The Causes of the Causes Versus The Causes

16. 2005 CAUSES CAUSES of the CAUSES

17. Fleeing the Medical Model,Embracing the Medicine Wheel

18. Public Health 101

19. 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 ?

20. 2. Would you prefer: A) Clean air B) Enough puffers and respirators for all

21. 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

22. 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

23. The U.S.A. Life Liberty The pursuit of Happiness Canada Peace Order Good government The Citizen and the Constitution MoniqeBégin

24. Physicians per capita: 2.4/1000 pop. Nurses: 10.6/1000 Acute care beds: 2.7/1000 MRIs: 19.5/1 million pop. Life expectancyatbirth: 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 expectancyatbirth: 80.7 years Infant mortality rate: 5/1000 live births Obesity in adults: 15% OECD 2007 data justreleased Monique Bégin

25. U.S.A: Health care = a marketcommodity Medicare and Medicaid CANADA: Health care = a universalcommon good for all citizens of all ages, all conditions All universities are public and heavilysubsidized by bothlevels of government Monique Bégin

26. Who pays for health care? (2007)

27. "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.

28. "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

29. "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.

30. "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.

31. "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.

32. "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.

33. "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.

34. Issues with Canadian health care • Wait times: the one big complaint. Nowaddressedwith a national plan/special budget. • Adequatesupply of physicians and nurses: at long last increasingsince 2000. • Capital investment for CTs and MRIs: stilllacking. Need for PET scans • Most appropriate care, mostappropriate provider (paid & unpaid), mostappropriate place.

35. The Grey Tsunami ? R.O.M.P. Collingwood April 24, 2008 Dr. Carolyn Bennett M.P. The Grey Tsunami ?

37. What do Canadiansthink of their system? • OECD study of 10 countries … • US least satisfiedwith the care theyreceive • Canadians 5X more likely to besatisfiedwiththeir care • The Nanos Researchpoll, 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 improveCanada's national health care system. • The Harris-Decimapoll, earlyJune 2009: • found 70% of Canadianssay the system isworkingvery or fairlywell. Monique Bégin

38. 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.

39. 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

40. The Goal • Most appropriate care • In the most appropriate place • By the most appropriate person – paid and unpaid

41. Federal Government must lead by example 5th biggest provider of health care • Aboriginals • Military • Veterans • Corrections • RCMP • Public Service

42. “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