new attitudes: toward transformative change in health care

New Attitudes:

Toward Transformative Change in Health Care

Today in Canada

Canada spends more on health care than most other countries

We rank 8th out of 28 OECD countries in terms of health spending as percentage of GDP

Canada ranks 5th in the OECD in terms of health spending per capita

Today in Canada

Even though spending on health has increased, many Canadians still cannot access timely care:

About 5 million Canadians do not have a family physician

Emergency department waits and wait times for elective procedures are still too long

Many Canadians have no supplemental health insurance

Fact-Finding Mission

5 countries: UK, Denmark, Belgium, Netherlands, France

Met with approximately 36 organizations/groups (over 75 people)

Types of organizations included: Ministries of Health (national and EU) National medical associations and physicians Other providers: Hospitals, nurses, public health Health research institutes (national and international) Other (patient group, IT organizations)

Goal: to study the “what” and “how” of health transformation

Key Learnings

European countries organise, manage and finance health care in different ways. But the systems

share some common principles: universal access to care and insurance, solidarity in the distribution

of costs and a good standard of care.

Netherlands Ministry of Health, Welfare and Sport.

UK – Key Learnings

The UK has been successful in addressing long wait times, particularly for specialty care, by: Having strong political leadership 100% activity based funding Using incentives and setting targets-- holding officials

accountable if they are not met Introducing “contestability” (competition) into NHS to

improve performance (e.g., Independent treatment centres) Focusing on patient flow and process management to move

patients through system efficiently (4-hour wait time guarantee)

Public reporting on progress (transparency)

Denmark – Key Learnings

Have successfully addressed wait times by: Activity-based funding for hospitals (50% of budget) 1 month patient wait-time guarantee, after which patient is

referred to private system for care 48 hour treatment guarantee and care package for cancer

diagnoses (fast track) Municipalities manage administration of long-term care services Greater transparency including star rating of hospitals

Adopted “clinical support” approach for IT strategy Lab reports, prescription Online appointment booking

Belgium – Key Learnings

High degree of public satisfaction with system - No waits for medical care

Equal access and freedom of choice Independent medical practice, free choice of health

care provider, fee-for-service payment, activity-based funding for hospitals

Can access specialists directly without referral Same-day appointment with FPs

Co-payments for care: approximately 25% but with a maximum ceiling and lowered for disadvantaged

Netherlands – Key Learnings

Hybrid approach: private health insurance for all regulated by law with strong public statutory safeguards

Funding follows patients – everyone is equal

Wait times have been significantly reduced No longer an issue

Netherlands — Key Learnings (continued)

Improving quality of services is a major priority of both health insurers and by ministry of health

Quality is a factor when insurers contract with providers Hospital performance reports National improvement program on professional quality

France – Key Learnings

Social security-style health insurance system – largely employer and employee contributions and taxe

60% of elective surgeries are perfromed in private clinics, but are paid for with public funds

The French are very proud of their system

Major Findings

There is no one perfect system

We can’t simply import all of the initiatives from Europe (need a “Made-in-Canada” solution)

We can use best practices and apply them to the Canadian reality.

Common Themes: The “What” on European Health Systems

All countries visited feature:

Higher supply of physicians than in Canada Activity-based funding of hospitals Active use of incentives and competition to increase productivity A public-private mix of some kind (e.g., co-payments, publicly-

funded independent contractors, private insurance) A desire for greater transparency and for patients to play a

stronger role in choosing their care

Common Themes: The “What” (cont’d.)

All systems based on principles of Universality and Solidarity

Wait times no longer a serious issue

Governments focused on improving quality of care

Common Themes: The “What” (cont’d.)

Physician shortages are not an issue in Europe

Unlike in Canada, there is no debate over the role of public/private

Health care remains a political issue

Disbelief when told of the wait times facing patients in Canada

How changes were made in Europe

Vision is clear and political leadership solid

Wait times often the issue that forces change

“Quick wins” in the short term are important (for example, activity-based funding)

Put more power in the hands of patients to steer change

Lessons for Canada from Europe

There are options to improve our health system without compromising universality

Activity-based/patient-focused funding for hospitals is critical

Create incentives to improve access (e.g. competition and public reporting)

Never lose sight of quality Invest in IT support

Directions for Transformation

1. Change in attitudes/culture toward patient-focused care

Understand that it is possible to transform the health care system, other countries have done it

European model rather than American

Change in attitude among physicians required (better client service)

Change in societal attitude needed


2. Partial activity-based funding for hospitals

Money follows the patient

Activity-based funding can be partial

The patient becomes a source of revenue and not of cost

Accountability


3. Competition and contracting out of services

Delivery of services by the private sector, but paid for by the State

France

NHS


4. Incentives to support quality care/outcomes

Financial incentives for communities that succeed in reducing hospitalization rates

transparency


5. Adoption of better health human resource policies

Access to primary care

Collaborative care teams

Physician assistants


6. Adopt an arm’s-length health funding model

Independent agency, separate from government

Less political influence

Greater transparency


7. Direct IT funding and policy first at patient-provider level


8. Institute an appropriate system of long-term care

Emergency

Hospital

Long-term care

“Change will not come if we wait for some

other person or some other time. We are

the ones we’ve been waiting for. We are

the change that we seek.”

– Barack Obama

This presentation is available at www.cma.ca

new attitudes: toward transformative change in health care

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