Title: Its Time for Tommy Douglas Second Stage of Medicare
1Its Time for Tommy Douglas Second Stage of
Medicare
- Michael M. Rachlis MD MSc FRCPC
- www.michaelrachlis.com
- SOS Medicare 2 Looking Forward
- May 4, 2007 Regina Saskatchewan
2Outline
- What is the Second Stage of Medicare?
- Where did the Second Stage come from and why are
we still waiting for it? - What are the Principles for the implementation of
the Second Stage? - Why do we need the Second Stage of Medicare now?
3What is the Second Stage of Medicare?
4We need to change the way we deliver care
- Removing the financial barriers between the
provider of health care and the recipient is a
minor matter, a matter of law, a matter of
taxation. The real problem is how do we
reorganize the health delivery system. We have a
health delivery system that is lamentably out of
date. - Tommy Douglas
5Only through the practice of preventive medicine
will we keep the costs from becoming so excessive
that the public will decide that Medicare is not
in the best interests of the people of the
country.
Tommy Douglas
We need to focus on prevention
6What is the Second Stage of Medicare?
- Stage One Provide financial support for care
when people get sick. - Stage Two The more difficult task ---keeping
people well.
7The Mission In the Second Stage of Medicare we
will continuously reduce
- Unnecessary deaths,
- Unnecessary pain and suffering,
- Unwanted waiting
- Helplessness
- Waste
Modified from Institute of Medicine 2001
8Where did the Second Stage come from and why are
we still waiting?
91945 -- Swift Current Region 1 health services
based on prevention with
- Prepaid funding Services available on a
universal basis, with little or no charge to
users. - Integrated coordination of health care delivery
through the creation of local integrated health
regions which fund a comprehensive package of
services including hospital and physician care,
diagnostic services, home care, public health and
dental services. - Group medical practice with doctors working in
teams with nurses, social workers and other
providers. In the original plans, the medical
officer of health was the medical director. - Democratic community governance of health care
delivery by locally elected community based
boards.
10What happened to the vision?
- Despite Swift Current Regions success,
Saskatchewan MDs wanted independent practice paid
on fee for service - Saskatchewan MD strike of 1962
11What happened to the vision?
- Despite the Hall Commission, the feds only cover
medical care - Dr. John Hastingss 1972 Report is mainly
ignored, except in Quebec - Canada inspires other countries policy
- Lalonde Reported, Ottawa charter of Health
Promotion, Etc - The Canada Health Act stops the bleeding
- But its only temporary
12What happened to the vision?
- 1990s cutbacks harm a vulnerable system
- Waits and delays worsen
- More specialties and special units
- Cant admit people for investigations
- We cant keep it secret anymore -- Poor
quality care kills thousands
13(No Transcript)
14Houston, we have a quality problem (like other
countries)
- One in 14 Canadian hospital patients suffers a
complication while in hospital (Baker Norton
Flintoft 2004) - There are 9,000 to 24,000 deaths that occur in
hospital every year which could be prevented
(4-11 of all deaths)
15Our health system doesnt deal well with chronic
diseases
- lt 30 of Canadians hypertensives have their blood
pressure properly controlled - 60 of diabetics have gone gt 1 yr without an eye
exam or a check for proteinuria - 24 of asthmatics are properly controlled and 57
are poorly controlled - Up to one in six seniors is re-admitted to
hospital within 30 days of discharge
16Do one-quarter of older Canadian women need to
take Benzos? Benzos cause one-fifth of Quebecs
broken hips.
- Do we care what were paying for?
17The Second Stages Essence delivering health
services differently to keep people well
18The Second Stage of Medicare meets the Quality
Agenda
- Are we providing the safest, most suitable care?
Are we investing enough in prevention? Are we
reducing inequalities in health? The answer to
these questions is no, not yet. But we could. It
is the Councils belief that we already have
strong evidence and enough experience to pursue a
quality agenda. - Health Council of Canada 2006
19Second Stage of Medicare Principles
- Essential Principles What we Want1. Population
Health Focus 2. Equitable3. Patient-Centred - 4. Effective5. Accessible6. Safe
- Instrumental Principles How we get
there7. Efficient8. Accountable9. Appropriately
resourced - 10. Non-profit
20Population Health Focus We should continuously
improve the health of the population.
- Our health system was largely designed to treat
acute illness and federal legislation only
requires the provinces to cover hospitals and
physicians services. - The key strategy is intersectoral action which
requires changes in the organization of
government, e.g. Saskatchewan Human Services
Integration Forum
21Equitable We should continuously reduce
disparities in health
- Men live 6 years less than women
- Women have more chronic, non-fatal conditions
than men - Aboriginal men live seven years less than
non-Aboriginal men - Poor men live 5 years less than rich men
- Infant mortality is 70 higher in poor
neighbourhoods than rich neighbourhoods - Northern Canadians have the lowest life
expectancy - 20 of health care costs are related to
disparities - There are inequalities in access to health care
by income in all developed countries
22A 3-pronged attack on disparities
- Improving the accessibility of the health system
through outreach, location, physical design,
opening hours, and other policies. Vancouver
Coastal Health - Improving the patient-centredness of the system
by providing culturally competent care,
interpretation services, and assisting patients
and families surmount social and economic
barriers to care. London Intercommunity Health
Centre - Cooperating with other sectors to improve
population health. Saskatoon Health Region
23Patient-Centred care respects individuality,
ethnicity, dignity, privacy, and information and
the patients family. Patients should control
their own care
- The average patient requires 90 seconds to
explain a problem but the average doctor
interrupts the average client in only about 20
seconds - Patients are capable of fully-informed
decision-making in less than 10 of physician
visits
24Patient-Centred respects individuality,
ethnicity, dignity, privacy, and information and
the patients family. Patients should control
their own care
- Saskatoons Sherbrooke Community Centre
- The Eden Alternative creates paradise
- I used to cry every time I left him. I dont cry
anymore. - Centre for Addictions and Mental Health
- Leadership in diversity
25Effective The best science should ensure most
appropriate care possible.
- Care is too often not based upon evidence
- It often takes 15-20 years after an innovations
development before it becomes routine practice. - Sault Ste. Marie Group Health Centre
- Electronic health records
- 50 reduction in readmissions of heart failure
patients - Diabetes and Vascular Intervention Project
- Tracking 5000 diabetics
26Accessible Patients should get timely care. Waits
should be continuously reduced
- Advanced Access same day service
- Penticton, Toronto, Saskatchewan
- Hamilton shared Care Mental Health
- 145 GPs, 80 counsellors, 17 psychiatrists
- 1100 ? in patients seen for mental health
- 70? in referrals to psychiatrists
- Alberta Bone and Joint Pilot Project
- Reduced wait times for hip and knee replacements
from 19 months to 11 weeks
27Safe People should not be harmed. We should
continuously reduce adverse events.
- Safer Health Care Now (http//www.saferhealthcaren
ow.ca/) - 600 safety improvement teams in over 180 health
care organizations - NS South Shore District Health Authority had no
ventilator associated pneumonias in 14 months - Pharmacists in primary health care
28Why do we need the Second Stage of Medicare now?
29Why do we need the Second Stage of Medicare now?
- Aging of the population and chronic disease put
extra pressures on an inefficient system - The workforce is getting older and sicker
- Family doctors are exiting comprehensive care
- Nurses and other health workers face burnout
- We need to improve the sustainability of the
system
30Many attribute the quality problems to a lack of
money. Evidence and analysis have convincingly
refuted this claim. In health care, good quality
often costs considerably less than poor quality.
- Fyke Report 2001 (Saskatchewan)
31Quality provides sustainability
- Alberta aftercare program for congestive heart
failure patients leaving hospital reduced future
hospital use by 60 with 2500 in overall net
cost savings per participant. - New Westminster's Royal Columbian Hospital
reduced post heart surgery pain complications by
80 and length of stay by 33. - BCs Reference Drug Program kept Vioxx as a
second line drug and saved 23 million per year
and dozens of lives.
32Quality provides sustainability
- Quality workplaces improve the health of workers
and patients - Quality workplaces could be worth a one years
graduating class of nurses
33Facilitating the Second Stage
- Pay providers fair and equitable compensation so
they can meet their patients needs wherever they
may be - Implement electronic health records ASAP
- Increase training budgets
- The Saskatchewan Health Quality Councils Chronic
Disease Collaborative improving primary health
care for 25 of the province - A network of public health oriented PHC centres
- Could the federal government do this?
- Supportive housing
- And other social policies
34What Canadians want to hear?
- Medicare was the right road to take
- Resources arent the major problem. Costs are not
out of control but neither is the system
drastically underfunded. We need transition
funding - Medicare was designed for another time and was
implemented as a compromise - If Douglas had had his way in the 1940s and 1950s
Medicare would have many fewer problems today - There are public sector solutions for every one
of Medicares problems The Second Stage of
Medicare
35For profit patient care tends to be more
expensive and of poorer quality but the most
effective argument is You dont need to even
think about it!
36Summary
- Our health services are rife with problems
because we failed to implement the Second Stage
of Medicare - The essence of the Second Stage of Medicare is
re-organizing health services delivery to focus
on prevention - We need to implement the Second Stage of Medicare
or we risk losing the First
37Courage my Friends, Tis Not Too Late to Make a
Better World!