HEALTHCARE REFORM IN SASKATCHEWAN IN THE 1990s:LESSONS FROM THE MINISTER OF HEALTH

Louise SimardMinister of Health, Saskatchewan (1991 – 1995)

THE CONTEXT

• 1962: Saskatchewan birthplace of medicare in Canada– publicly

funded/administered, universal access

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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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THE CONTEXT

• First priority: get annual deficit under control• Second priority: revamp healthcare– Stakeholders recognized need– Many commissions (e.g. Murray Commission)• Wellness Model

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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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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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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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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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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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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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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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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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MORE REFORM INITIATIVES

• Over the next two years more and more initiatives were undertaken to accommodate health reform

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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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REFLECTIONS• Ingredients for successful change management

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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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REFLECTIONS

• Patient First Review (the Dagnone Commission)– focus on patient-

and family-centred care

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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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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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QUESTIONS?

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