Health innovation for all conference sustaining and transforming our health systems
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IHI Open School UBC Chapter, Health Innovation for All Conference. Sustaining and Transforming Our Health System(s) Presentation by: Paul W. Gallant, Gallant HealthWorks Session Summary: This interactive workshop encourages participants to contribute their knowledge, views and experiences as health system(s) stakeholders to discuss questions based on the concepts and trends presented.
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Health innovation for all conference sustaining and transforming our health systems
- 1. Sustaining & Transforming Our Health System(s) HEALTH INNOVATION FOR ALL CONFERENCE University of British Columbia, Vancouver June 10, 2017 Paul W. Gallant, MHK, BRec (TR), CHE Principal, GALLANT HEALTHWORKS & Associates Certified Health Executive www.GallantHealthWorks.com Permission for non-commercial use granted when referencing Paul W. Gallant, GALLANT HEALTHWORKS (2017). Contact the presenter for commercial use.@HealthWorksBC
- 2. Session Objectives: 1. To enjoy ourselves 2. To introduce the concepts of cost, efficiency, effectiveness in the health system 3. To understand trends in costs and their impact on the future of health systems 4. To learn how to incorporate this knowledge in effecting change www.GallantHealthWorks.com @HealthWorksBC 2
- 3. Workshop Participants (photo added after the workhop) • Medical Students/Physicians • Nurses/Nursing Students • Health Admin. Students • Faculty & Researchers • QI Consultants • Other Health Professionals www.GallantHealthWorks.com @HealthWorksBC 3
- 4. Stories • Emergency departments • Mental health • Seniors care • GPs/Family doctors • First Nations • Budget • Data www.GallantHealthWorks.com @HealthWorksBC 4
- 5. 5
- 6. Medicare • refers to Canada's publicly funded health care system • 13 provincial & territorial health care insurance plans. • all Canadian residents have reasonable access to medically necessary hospital & physician services without paying “out-of- pocket.” www.GallantHealthWorks.com @HealthWorksBC 6
- 7. Provincial & Federal Responsibility • Roles and responsibilities for health care services are shared between provincial and territorial governments and the federal government. • The provincial and territorial governments are responsible for the management, organization and delivery of health care services for their residents. • The federal government is responsible for: • setting and administering national standards for the health care system through the Canada Health Act • providing funding support for provincial and territorial health care services • supporting the delivery for health care services to specific groups • providing other health-related functions www.GallantHealthWorks.com @HealthWorksBC 7
- 8. Federal Funding for Health Care • provides health care funding to the provinces and territories through the Canada Health Transfer. • Provinces and territories receive additional federal funding support through other fiscal transfers. • Delivering health care services to specific groups including: • First Nations people living on reserves • Inuit • serving members of the Canadian Forces • eligible veterans • inmates in federal penitentiaries • some groups of refugee claimants www.GallantHealthWorks.com @HealthWorksBC 8
- 9. www.GallantHealthWorks.com @HealthWorksBC 9 The Fraser Institute
- 10. Spending Health Care Vs Other 2001, 2016, 2031 www.GallantHealthWorks.com @HealthWorksBC 10 Source: The Fraser Institute
- 11. BC Funding Office of the Auditor General of BC, 2017
- 14. Efficiency • a relationship between what it costs and what service is received what outcome is achieved • efficiency measured as the effectiveness with which health systems use their resources to reduce potential year of life loss (PYLL) due to treatable causes of death. • corresponds to the technical efficiency of the health system. It refers to maximizing the level of outputs for a given level and mix of inputs, or minimizing input use for a given level of outputs. • Improving health system efficiency is seen as one way to ensure its sustainability www.GallantHealthWorks.com @HealthWorksBC 14
- 15. Effectiveness • Effectiveness of services corresponds to the capacity of the services delivered to reduce the incidence, duration, intensity and consequences of health problems. CIHI: A Performance Measurement Framework for the Canadian Health System www.GallantHealthWorks.com @HealthWorksBC 15
- 16. • Do efficient and effective health systems necessarily equal better health care & better health? www.GallantHealthWorks.com @HealthWorksBC 16
- 20. Effective • Chhosing Wisely • Antibiotics www.GallantHealthWorks.com @HealthWorksBC 20
- 21. “Sustaining” and “transforming” defined as the terms relate to health systems. Workshop participant exercise Sustaining Transforming www.GallantHealthWorks.com @HealthWorksBC 21
- 22. Small Group Task • Choose & discuss one of the questions given to your assigned table • Express you viewpoints – allow time for others to comment • Ask questions to each other, clarify • Document at least four key messages on the flip chart sheet www.GallantHealthWorks.com @HealthWorksBC 22
- 23. Small Groups discussed one of these questions(photo added after the workhop) What Needs To Be Sustained in Our Health System(s)? OR What Needs to be Transformed in Our Health System(s)? www.GallantHealthWorks.com 2 3
- 24. What Needs To Be Sustained in Our Health System(s)? • Universal Access*** • Funding Models*** to improve equitable access & lower indirect costs to patient, for community care (support for non-profit) • Affordability • Transitions in care: cradle to grave, continuity of care especially hospital to home or LTC, primary care to specialty, QI that tracks transitions in care ***reported by three or more groups
- 25. What Needs To Be Sustained in Our Health System(s)? SDOH – standard of living Patient centred care Innovation Training of professionals re. patient family centred care First Nations autonomy & recognition Prioritization of health care
- 26. What Needs to be Transformed in Our Health System(s)? • SDOH**- more focus on improving • Cost transparency • Payer-provider separation • Pharma Care (access to essential list, negotiating prices of meds with pharma companies) • Fee for Service -Physician payment -greater access to care for all pops. **reported by 2 or more groups • Technology (e.g. Estonia’s eHealth) -greater client education, use & engagement -data storage-infrastructure -data management -better policy guidelines -IPE-like programs in more institutions -mandatory www.GallantHealthWorks.com @HealthWorksBC 26
- 27. What Needs to be Transformed in Our Health System(s)? • Public Understanding -patients as partners -awareness -education -self-sufficiency • Better integration of whole- person care (dentistry, vision, behavioral) • Access and Rural Health • Community based care • Medical home Care • Equitable care • Opioid Crisis • Inter-professional Collaboration • Communication & Interconnectedness • Health promotion www.GallantHealthWorks.com @HealthWorksBC 27
- 28. Summary Presented but not documented here www.GallantHealthWorks.com @HealthWorksBC 28
- 29. Resources • International Profiles of Health Care Systems http://www.commonwealthfund.org/publications/fund-reports/2017/may/international-profiles • Efficiency, effectiveness, equity (E3). Evaluating hospital performance in three dimensions, Health Policy http://www.sciencedirect.com/science/article/pii/S0168851013000602 • Deber R. Healthcare Quarterly [Internet]. Why Did the World Health Organization Rate Canada’s Health System as 30th? Some Thoughts on League Tables: Longwoods.com. [cited 2017Jan1]. http://www.longwoods.com/content/17238 • Health Funding Explained 2. Office of the Auditor General, BC 2017 http://www.bcauditor.com/pubs/2017/health-funding-explained-2 http://www.myprincegeorgenow.com/44234/bc-auditor-general-breaks-health-care-spending- british-columbians/ • Policy Note http://www.policynote.ca/bcbudget2017/#sthash.8mr6XvY9.dpuf http://www.policynote.ca/bcbudget2017/ • Global health care outlook, Battling costs while improving care https://www2.deloitte.com/...Health-Care/gx-lshc-2016-health-care-outlook.pdf Paul W. Gallant www.GallantHealthWorks.com Twitter @HealthWorksBC 29
- 30. Resources (Cont’d)EeEEThis link is to caseEeEx • In Search of the Perfect Health System, Mark Britnell, 2015 (paperback) • Matters of Life and Death: Public Health Issues in Canada, Andre Picard, 2017 (paperback) • The Sustainability of Health Care Spending in Canada 2017 https://www.fraserinstitute.org/studies/sustainability-of-health-care-spending-in-canada • The Sustainability of Canada's Healthcare System: A Framework for Advancing the Debate. Healthcare Quarterly, 10(2) April 2007: 96-103. http://www.longwoods.com/content/18839 • Examples through Paul Gallant’s SlideShares http://www.slideshare.net/paulwgallant/ • On Twitter follow relevant hashtags and accounts including: • #ChoosingWisely @ChooseWiselyCA • @HealthWorksBC (Paul Gallant); • #cdnhealth • #bchc • #sdoh • #hcldr Paul W. Gallant www.GallantHealthWorks.com Twitter @HealthWorksBC 30
- 31. Contact or connect with the presenter….including workshop or presentation inquiries. www.GallantHealthWorks.com 31 https://www.linkedin.com/in/paulwgallant https://twitter.com/HealthWorksBC Email: info@GallantHealthWorks.com https://www.facebook.com/GallantHealthWorks
Editor's Notes
- https://twitter.com/HealthWorksBC/
- is a term that refers to Canada's publicly funded health care system. Instead of having a single national plan, we have 13 provincial and territorial health care insurance plans. Under this system, all Canadian residents have reasonable access to medically necessary hospital and physician services without paying out-of-pocket. Roles and responsibilities for health care services are shared between provincial and territorial governments and the federal government. The provincial and territorial governments are responsible for the management, organization and delivery of health care services for their residents. The federal government is responsible for: setting and administering national standards for the health care system through the Canada Health Act providing funding support for provincial and territorial health care services supporting the delivery for health care services to specific groups providing other health-related functions
- See the trend here and in the next slide. Other provinces are in a similar state.
- Fraser Institute
- “Not all areas of B.C.’s health-care system are expanding at the same rate.” From 2012-13 to 2015-16, acute- care (emergency, post-surgical, critical- care) spending went up 11%; residential care (seniors’ homes, community group homes) went up 5%; community care (in-home nursing care) went up 14%; mental-health and substance-use services went up 3%. Public health and wellness (prevention programs, screening, communicable disease control) went down 1%. Last year in B.C., the health sector spent $19.2 billion. Of that, the Ministry of Health spent $17.4 billion, or 37% of overall provincial expenses. This is three times more than the next largest ministry (Education). Health spending per person in B.C. is $4,050 annually; the Canadian average is $4,095. http://nationtalk.ca/story/b-c-s-health-care-costs-reach-19-2-billion-and-rising Public health and wellness down 1%
- Economist Hospitals fear cost-effectiveness means lower reimbursements. Hospital administrators often resist efforts to reduce hospital occupancy for fear that decreases in revenue will jeopardize their ability to cover large fixed costs. For this study we used the treatable potential years of life lost (PYLL), an indicator that calculates the number of years of life that are lost prematurely (here, before age 80) to causes of death that are considered to be treatable by healthcare interventions (CIHI 2012b; Nolte and McKee 2004, 2008). The underlying idea is that if Canadians had access to timely care when they need it, no person should die before age 80 of (the small set of ) causes of death that are considered to be treatable. In practice, this means that a person who died at age 65 from a treatable cause of death would have lost 15 potential years of life. These values of the difference between the actual age of death and age 80 are then summed over the population and divided by the population count. The choice of age 80 as the cut-off for considering a death to be premature was based on stakeholder feedback, Efficiency reflects the extent to which health system objectives are met, given the resources invested in the system.2 In the wake of the recent economic downturn, efforts to ensure that resources are used so they achieve the best possible performance are especially timely, given the tight budget constraints faced by health system managers. In this study, the health system includes all activities under the jurisdiction of provincial and territorial ministries of health. Measuring health system efficiency has been the focus of several high-profile international studies. In 2000, the World Health Organization (WHO) conducted a comprehensive analysis of health system efficiency across all 191 member states.3 This analysis stimulated a flurry of dialogue around health system performance measurement, including its methodological and conceptual challenges.4 The WHO analysis looked at the efficiency with which the health system achieved the aggregate of five performance objectives: average level of health status, inequalities in health status, responsiveness, inequalities in responsiveness and fairness of financial contribution.3 Canada ranked 30 out of the 191 countries in this study. Canada was also part of an Organisation for Economic Co-operation and Development (OECD) study that compared different approaches to measuring efficiency using one common approach in the literature, data envelopment analysis (DEA). Canada ranked 14 out of 30 OECD countries, a ranking that suggests life expectancy could be increased by nearly two years and amenable mortality could be reduced by about 20% if the health system was performing optimally.5 International studies provide insight into the potential gains to be realized with improvements in efficiency. However, given the provincial and, increasingly, regional responsibilities for health system delivery and administration in Canada, it is important to examine efficiency at the regional level within Canada.6
- There is great interest in Canada and other countries in ensuring that health system resources are used effectively. Improving health system efficiency is seen as one way to ensure its sustainability.1
- It depends
- (Community example large primary health community) Meaningfully Engaged: Meaningful change in the health system - that will ensure an affordable system with the best patient experiences and best health outcomes, can only happen when we all work together. Each table: youth, seniors, adults with substance use, mental health Health