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Its Time for Tommy Douglas Second Stage of Medicare

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Canada inspires other countries' policy ... Tracking 5000 diabetics. Accessible Patients should get timely care. ... Hospital reduced post heart surgery pain ... – PowerPoint PPT presentation

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Title: Its Time for Tommy Douglas Second Stage of Medicare


1
Its 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

2
Outline
  • 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?

3
What is the Second Stage of Medicare?
4
We 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    health delivery system that is lamentably out of
    date.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

5
Only 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
6
What 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.

7
The 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
8
Where did the Second Stage come from and why are
we still waiting?
9
1945 -- 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.

10
What happened to the vision?
  • Despite Swift Current Regions success,
    Saskatchewan MDs wanted independent practice paid
    on fee for service
  • Saskatchewan MD strike of 1962

11
What 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

12
What 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)
14
Houston, 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)

15
Our 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

16
Do 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?

17
The Second Stages Essence delivering health
services differently to keep people well
18
The 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

19
Second 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

20
Population 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

21
Equitable 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

22
A 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

23
Patient-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

24
Patient-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

25
Effective 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

26
Accessible 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

27
Safe 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

28
Why do we need the Second Stage of Medicare now?
29
Why 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

30
Many 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)

31
Quality 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.

32
Quality provides sustainability
  • Quality workplaces improve the health of workers
    and patients
  • Quality workplaces could be worth a one years
    graduating class of nurses

33
Facilitating 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

34
What 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

35
For 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!
36
Summary
  • 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

37
Courage my Friends, Tis Not Too Late to Make a
Better World!
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