New Models of General Practice: Practical and policy lessons
Louise Simard: Healthcare reform in Saskatchewan in the 1990s
1. HEALTHCARE REFORM IN
SASKATCHEWAN IN THE 1990s:
LESSONS FROM THE MINISTER OF HEALTH
Louise Simard
Minister of Health, Saskatchewan (1991 – 1995)
2. THE CONTEXT
• 1962: Saskatchewan
birthplace of medicare in
Canada
– publicly
funded/administered,
universal access
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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
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4. THE CONTEXT
• First priority: get deficit under control
• Second priority: revamp healthcare
– Stakeholders recognized need
– Many commissions (e.g. Murray Commission)
• Wellness Model
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5. FORMING GOVERNMENT
• Oct. 1991: Social democrats form government
– dramatic action taken, reverberates through
province
– large “umbrella boards” in Saskatoon and Regina
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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
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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
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8. TWO STAGES OF THE REFORM PROCESS
1. Reorganization of the governance and
delivery structures of the health system
2. 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
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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%
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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
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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
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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
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13. MORE REFORM INITIATIVES
• Over the next two years more and more
initiatives were undertaken to accommodate
health reform
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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
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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.
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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
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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
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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
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