Louise Simard: Healthcare reform in Saskatchewan in the 1990s


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Louise Simard: Healthcare reform in Saskatchewan in the 1990s

  1. 1. HEALTHCARE REFORM INSASKATCHEWAN IN THE 1990s:LESSONS FROM THE MINISTER OF HEALTH Louise Simard Minister of Health, Saskatchewan (1991 – 1995)
  2. 2. THE CONTEXT• 1962: Saskatchewan birthplace of medicare in Canada – publicly funded/administered, universal access 2
  3. 3. THE CONTEXT• Federal government was financing about 55% of healthcare costs; contributions reduced in late 70s/early 80s• 1984: Canada Health Act• 1991: A perfect storm for Saskatchewan 3
  4. 4. THE CONTEXT• First priority: get deficit under control• Second priority: revamp healthcare – Stakeholders recognized need – Many commissions (e.g. Murray Commission) • Wellness Model 4
  5. 5. FORMING GOVERNMENT• Oct. 1991: Social democrats form government – dramatic action taken, reverberates through province – large “umbrella boards” in Saskatoon and Regina 5
  6. 6. MANAGING REFORM• Over 400 boards collapsed into 30• Strategic approach to community involvement – public consultation and stakeholder buy-in essential• Social determinants lens• Provincial Health Council, Utilization Commission established 6
  7. 7. MANAGING REFORM• Two competing goals – deficit reduction, not reform per se – focus on revamping healthcare system and population health• Announcements of hospital conversions and cuts to services posed political challenges 7
  8. 8. TWO STAGES OF THE REFORM PROCESS1. Reorganization of the governance and delivery structures of the health system2. Reform of service, program and delivery methods – long term and evolutionary in nature – primary health care, population health goals – community involvement, control over system – increased coordination, integration of services 8
  9. 9. CUTS TO SERVICES• Early 1992: provincial government set stage for significant cuts, 3.3% – community-based services spared – hospital, physician, optometric, chiropractic and prescription drug funding decreased• 3.3% cut felt more like a 10% cut, since growth in healthcare spending had been escalating annually by at least 7% 9
  10. 10. HOSPITAL CONVERSIONS• 1993: Government sought further savings – closure (conversion) of acute care beds in 52 rural hospitals • converted to health centres, which would deliver more appropriate services • even after conversions, beds per capita higher than in most provinces 10
  11. 11. HOSPITAL CONVERSIONS• public outcry and disapproval of new policies – Important to • face the people and explain policies • set deadlines • develop strategy to cope – Implementation of guidelines, first-responder system, labour adjustment strategy, rural initiatives fund, trial runs 11
  12. 12. DISTRICTS• Aug. 1993: deadline to establish District and set requirements – “A Guide to Core Services for Saskatchewan Health Districts” • outlined basic services expected to be provide in the short term, and services that would eventually be transferred from government – all 30 districts established and rural hospitals converted as planned • day of conversions, non-issue in media • lower mortality 12
  13. 13. MORE REFORM INITIATIVES• Over the next two years more and more initiatives were undertaken to accommodate health reform 13
  14. 14. HEALTH HUMAN RESOURCES• Restructured provincial health sector bargaining units (The Dorsey Commission) – 500 bargaining units and 21 collective agreements in health sector prior to reform – 35 bargaining units and 6 collective agreements in health sector after reform• Labour reorganization removed the final barrier to integrated health services delivery 14
  15. 15. REFLECTIONS• Ingredients for successful change management • reform needs a champion • vision needs to be • importance of setting the scene communicated to the public • reform needs to be launched • clear deadlines for early in a government’s accomplishing the various steps mandate • public opinion leaders part of • research must support the the process change • the plan needs to be flexible • a vision and the goals clearly • critical management of issues defined as they arise or anticipated and • the vision needs to offer hope dealt with before they become • stakeholder involvement in the an issue; development of the vision and • consistency of the message goals needs to be maintained. 15
  16. 16. REFLECTIONS• 30 years later, reform structure in place, but still evolving• Review of the reform (the Fyke Commission) – less health regions, another round of restructuring• Population health focus – improved, but much more to be done 16
  17. 17. REFLECTIONS• Patient First Review (the Dagnone Commission) – focus on patient- and family-centred care 17
  18. 18. HEALTH OUTCOMES• Perceived very good or excellent health status of SK people stable from 1994 to 2007• Infant mortality rates declined in SK and Canada from 1991 to 2007• Life expectancy at birth and at age 65 have been steadily increasing in SK – Rates are similar in SK and Canada, with slightly higher rates in Canada 18
  19. 19. RESOURCE USE• While the number of physician visits dropped by 17% between 1991-92 and 2000-02, the number of prescriptions filled increased by 31%• In 1999, health spending in SK below national average ($2,907 versus $2936) – spent less on hospitals, drugs, doctors and other professionals, but more on long-term care and other health expenditures 19
  20. 20. QUESTIONS? 20