new attitudes: toward transformative change in health care
Post on 11-Jan-2016
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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
Directions for Transformation
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
Directions for Transformation
3. Competition and contracting out of services
Delivery of services by the private sector, but paid for by the State
France
NHS
Directions for Transformation
4. Incentives to support quality care/outcomes
Financial incentives for communities that succeed in reducing hospitalization rates
transparency
Directions for Transformation
5. Adoption of better health human resource policies
Access to primary care
Collaborative care teams
Physician assistants
Directions for Transformation
6. Adopt an arm’s-length health funding model
Independent agency, separate from government
Less political influence
Greater transparency
Directions for Transformation
7. Direct IT funding and policy first at patient-provider level
Directions for Transformation
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
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