Moving Beyond the Policy Debate: How Process Improvements can Dramatically Impact Service Delivery in the Health Care System

1
Moving Beyond the Policy Debate How Process
Improvements can Dramatically Impact Service
Delivery in the Health Care System

• Canadian Federation of University Women
• Laura Zilney, Chair
• Health Committee
• October 2005

2
Background Canadian Federation of University
Women

• Founded in 1919, CFUW is a voluntary, not for
  profit, self-funded organization of over 10,000
  women university graduates
• members belong to 122 clubs active in every
  province in Canada
• CFUW is one of 78 member affiliates of the
  International Federation of University Women and
  its 140,000 members
• CFUW is a non government organization with
  special consultative status at the United Nations
  (Economic and Social Council) Commission on the
  Status of Women
• CFUW is committed to
• The pursuit of knowledge
• The promotion of education
• The improvement of the status of women and human
  rights and,
• Active participation in public affairs in a
  spirit of cooperation and friendship

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Presentation Outline

• Issues Challenges - specific studies/research
• Guiding Principles - following through
• Recommendations - standards and policing
• Critical Success Factors
• Closing Remarks - fair and gender specific
  treatment

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Issues Challenges (Page 1 of 2)

• Women are underrepresented in health research -
  leads to improper diagnoses/treatment,
  over-medicalization of womens health
• only in September 1996 did Health Canada revise
  its guidelines to require drug companies to
  include women in clinical trials in the same
  proportion as are expected to use the drug
• only 5 of Canadian health research funding is
  spent specifically on womens issues (Status of
  Women Canada)
• Women are often the first to suffer the effects
  of downsizing on the system (e.g. caregivers for
  those released from hospital earlier) - leads to
  increased economic burden, increased
  stress/anxiety
• women less likely than men to have private
  insurance and therefore bear the brunt of
  increased drug costs - cost of prescription drugs
  increased twice as fast as overall health
  expenditures between 1989-1998 (Cyrus Curtis
  2004)
• Women tend to prioritize their health lower than
  competing social, economic, environmental, and
  political concerns - even when changing cultural
  and social norms have increased womens level of
  risk (e.g. serial monogamy)
• women live 6.3 years longer than men, but only
  enjoy 1.5 more disability-free years of life
  (Health Canada 1999) does not necessarily
  translate into quality years of life

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Issues Challenges (Page 2 of 2)

• Women treated as homogeneous group -
  policies/procedures do not recognize differences
  based on ethnicity, immigrant status, education,
  class
• domestic violence/violence against women Health
  Canada recognizes this is a mostly female
  problem, but there is no consistency in terms of
  how this is dealt with in the health care system
  across Canada
• difference between women only noted in relation
  to specific problems e.g. Native women more prone
  to cervical cancer South-Asian and Black women
  at greater risk of heart attack/stroke - no
  explanations/analysis provided (Health Canada
  1999)
• Womens health not directly dealt with in health
  system or in policy - women treated for
  reproduction issues (pre and post natal)
• Health Canada (2003) concluded this may lead to
  womens exclusion from policy-making, research,
  medical research and therefore power within the
  system
• Political, economic, social, and environmental
  factors not analyzed when developing/modifying
  health policy
• No consistent experience/access to service across
  the country - leads to disparities between
  rural/urban, lower/middle or upper classes,
  young/old, women/men
• e.g. poor women often have reduced access to
  educational opportunities and decreased exposure
  to health-related information - results in lower
  income, poor nutrition, increased susceptibility
  to infection, chronic stress - all of which
  compound to impact womens health (Kitts
  Hatcher Roberts 2003)

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Guiding Principles

• Accountability
• financial
• service quality
• corporate and individual
• Consistency
• nationally
• between ethnic/cultural groups, geographic,
  gender
• Performance-based
• service outcomes
• Prevention-based
• Needs-based

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Recommendations

• Re-introduction of national health care standards
• provinces/territories required to provide
  Mandatory Programs in set program areas (e.g.
  Family Health, Chronic Disease Prevention)
• provinces/territories required to offer minimum
  number of Elective Programs in program areas that
  serve the needs of the community in which the
  health facility is located
• provinces/territories required to report back
  annually on set performance measures - if they
  fail to report/do not meet measures, federal
  monies cease or are reduced, as appropriate
• Provinces/territories provide health services
  through Combined Treatment Teams (CTT) to ensure
  consistency of experiences
• CTTs consist of physicians, nurse practitioners,
  nurses, social workers, nutritionists,
  physiotherapists, orthopedists

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Recommendations Service Delivery Breakdown
Federal Government

• Establish performance measures
• Provide monies via Canada Health Transfer

Provincial/Territorial Governments

• Ensure implementation of CTTs, Mandatory/Elective
  Programs
• Coordinate report-back to federal government

• Implement Mandatory and Elective Programs
• Report-back to Provincial/Territorial Government
• Operate CTTs

Municipal/Local Governments
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Critical Success Factors

• Mandatory Programs offered by provinces/territorie
  s must be enforceable and enforced - requires
  significant amount of work (e.g. Ontario)
• Clear roles between feds, provinces/territories,
  municipalities established
• Clear funding formula developed - should
  municipalities have taxation ability to
  supplement Mandatory and/or Elective Programs?
• Municipalities must be engaged in the process
  despite not necessarily having a controllership
  role (examples from across Canada indicate
  decreased engagement without controllership) -
  should this engagement be mandated? (e.g.
  Childrens Aid Societies)
• Clear process for determining how monies from
  feds is divided between each Mandatory Program
  (e.g. flexibility given to provinces/territories
  to determine breakdown, based on social need,
  based on cost to provide, etc.)

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Closing Remarks

• Need to move beyond gender-based analysis to
  substantive movement on process/procedural
  implementation
• Need to enforce what is already legislated in the
  Canada Health Act
• Federal Government needs to assume leadership
  role so health care is delivered strategically
  and equitably