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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

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Health health care understanding the future starts with the patient

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

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

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 marmot chair who commission on social determinants of health

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

Canadian Institute for Advanced Research

  • 25% attributable to health care system

  • 15% biology and genetics

  • 10% physical environment

  • 50% social and economic environments


Short history of canadian health care system

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


Fundamentals of canadian health care system since inception in 1957

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


Health health care understanding the future starts with the patient

Empowered Patient

Effective Advocate

Engaged Citizen


Health health care understanding the future starts with the patient

  • 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

Health Care or a Real System for Health


The tyranny of the acute

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

Citizens have to ‘get it’

  • More health …less health care

  • Service contract ??????

  • Or longer warranty ????


Social determinants of health vs choose health modifiable risks

Social Determinants of HealthvsChoose Health(modifiable risks)


The causes of the causes

The Causes of the Causes

Versus

The Causes


Health health care understanding the future starts with the patient

2005

CAUSES

CAUSES

of the

CAUSES


Fleeing the medical model embracing the medicine wheel

Fleeing the Medical Model,Embracing the Medicine Wheel


Public health 101

Public Health 101


1 do you think we should have a

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

2. Would you prefer:

A) Clean air

B) Enough puffers and respirators

for all


3 would you prefer that wait times were reduced by

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

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


The citizen and the constitution

The U.S.A.

Life

Liberty

The pursuit of Happiness

Canada

Peace

Order

Good government

The Citizen and the Constitution

MoniqeBégin


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 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


Health health care understanding the future starts with the patient

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


Who pays for health care 2007

Who pays for health care? (2007)


Health health care understanding the future starts with the patient

"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.


Health health care understanding the future starts with the patient

"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


Health health care understanding the future starts with the patient

"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.


Health health care understanding the future starts with the patient

"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.


Health health care understanding the future starts with the patient

"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.


Health health care understanding the future starts with the patient

"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.


Health health care understanding the future starts with the patient

"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.


Issues with canadian health care

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.


The grey tsunami

The Grey Tsunami ?

R.O.M.P.

Collingwood

April 24, 2008

Dr. Carolyn Bennett M.P.

The Grey

Tsunami ?


What do canadians think of their system

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


Health goals for canada

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 patients effective advocates engaged citizens

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

The Goal

  • Most appropriate care

  • In the most appropriate place

  • By the most appropriate person –

    paid and unpaid


Federal government must lead by example

Federal Government must lead by example

5th biggest provider of health care

  • Aboriginals

  • Military

  • Veterans

  • Corrections

  • RCMP

  • Public Service


Health health care understanding the future starts with the patient

“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


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