Brian Day Past President Canadian Medical Association
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Transcript of Brian Day Past President Canadian Medical Association
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Brian DayPast President
Canadian Medical Association
KananaskisFebruary 16th 2009
Coping with Change in Canada:Best and Emerging Practice
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Global Budget or Block Funding Global Budget or Block Funding
Less
Facilities Procedures Innovation Nurses Physicians Patients
Less
Facilities Procedures Innovation Nurses Physicians Patients
Less Care
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Patient Focused Funding
• PFFPFF• PbRPbR• P4PP4P• ABF ABF • SBFSBF• EBPEBP
Empowering the PatientEmpowering the Patient
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Orthopaedic Residents in Canada
Approximately 50% leave for US
“No jobs”
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Fig. 1 The quality-improvement cycle.
P4P must not become
“Pay for Paperwork”
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A Patient Focused System
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10%
36%
13%
3%
15%
23%
0%
5%
10%
15%
20%
25%
30%
35%
40%
Per
cen
t o
f R
esp
on
den
ts
Australia
Canada
Germany
New Zealand
United Kingdom
United States Worst: sick patients waiting 6 Worst: sick patients waiting 6 days plus to see doctordays plus to see doctor
Worst ranking:4 hours plus in E.R.
65% Children wait a medically 65% Children wait a medically unacceptable periodunacceptable period
Last in use of informationLast in use of informationtechnologytechnology
Last in use of interventionalLast in use of interventionalradiologyradiology
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Health Care and theEconomy
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The Cost of Waiting
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Four Targeted Areas $15 Billion January 2008 Wait Lists: an Unfunded Liability
Paying for the Privilege of Waiting
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“In total the economic burden was $51 billion…”
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MEDIX GP Survey on Wait Lists Pre-PbR
MEDIX GP Survey on Wait Lists Pre-PbR
• 66% - had patients admitted as emergencies• 90% - consultations from delays• 70% - significant problems from delayed treatment• 1.5 million extra consultations
• 66% - had patients admitted as emergencies• 90% - consultations from delays• 70% - significant problems from delayed treatment• 1.5 million extra consultations
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Market conditions and competition
Patient choice - quality and service
Local control
Bottom up instead of top down
Wait lists gone, productivity up
Carole Heatly
England:
the New NHS
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• The greatest change since 1948 • Patients choose from 350 hospitals, including private
• Bunions to heart surgery
• Flexibility and convenience for patients
• Stimulates failing hospitals to improve
• Patients avoid MRSA hotspots or wait lists
Patient Power and the New NHSDamien Fletcher , The Mirror, 31st March 2008
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Public Private Non Debate
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Worksafe BCWorksafe BCNo Waits for Injured WorkersNo Waits for Injured Workers
Worksafe BCWorksafe BCNo Waits for Injured WorkersNo Waits for Injured Workers
Health Care Costs1999 $204 million2002 $187 million
Health Care Costs1999 $204 million2002 $187 million
Health costs constant at $200 million per year for the past 10 years
Health costs constant at $200 million per year for the past 10 years
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“A System Focus”
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Data: Costing CMG HRG DRG
and Performance
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FOI Document Billings versus Costs
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Total Indirect Costs (per sample $1000 direct surgical
cost)
Total Indirect Costs (per sample $1000 direct surgical
cost)
BC Hospital A: Add $1220
BC Hospital B: Add $850
BC Hospital A: Add $1220
BC Hospital B: Add $850
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BC Medicare 15-16%1
U.S. Medicare and Medicaid 7-8%2
1Turchen, 20082 Matthews,2006
Measurement and Accuracy(Garbage in = Garbage Out)
Independent auditFederal FOI to include CIHIOutcomes clearly defined
Turchen 2008
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Costing and Accountability Calgary Health Region (CHR) Costing and Accountability Calgary Health Region (CHR)
“CHR administration argues that accurate cost accounting would require a diversion of effort better expended elsewhere”
“CHR administration argues that accurate cost accounting would require a diversion of effort better expended elsewhere”
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US Medicare:10 procedures, 4 Settings 2008
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2008 NHS Tariff Examples
Procedure NHS 2008 Tariff Cataract operation £786
Heart valve surgery £10,199
Heart bypass £8,080
Hip replacement £5,568
Hernia surgery £956
Knee replacement £6,182
Major breast surgery £2,386
Varicose vein removal £1,063
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Economic Impact of Early TreatmentEconomic Impact
of Early Treatment• Patients’ income• Medical expense• State revenue or payments• Medical tourism income
• Patients’ income• Medical expense• State revenue or payments• Medical tourism income
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Medical Tourism$20 Billion 2006$40 Billion 2007
$80 Billion 2008
U.S. Medical Tourists
¾ million 2008 6 million 201012 million 2012
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Service - Based Funding The Health of Canadians – The Federal Role
Final Report Volume Six
Service - Based Funding The Health of Canadians – The Federal Role
Final Report Volume Six
• Encourage efficiencies• Keep or reinvest savings• Create competition • Specialized teams• Centres of excellence • Improve quality with increased volume • Improve patient service • Reduce inefficiencies
• Encourage efficiencies• Keep or reinvest savings• Create competition • Specialized teams• Centres of excellence • Improve quality with increased volume • Improve patient service • Reduce inefficiencies “ “Kirby Report”
Senator Michael Kirby
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October 27 2006
October 27 2006
OECD: Competition in the Provision of Hospital ServicesOECD: Competition in the Provision of Hospital Services
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• Market mechanisms reduce government hospitals costs• Close hospitals or change management for poor results• Choice of provider• Capacity is needed• Rural hospitals benefit from benchmark competition• With long waits, funds following patients increases output• Centres of excellence may need entry constraints
• Market mechanisms reduce government hospitals costs• Close hospitals or change management for poor results• Choice of provider• Capacity is needed• Rural hospitals benefit from benchmark competition• With long waits, funds following patients increases output• Centres of excellence may need entry constraints
Competition in the Provision of Hospital Services
(OECD)
Competition in the Provision of Hospital Services
(OECD)
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ONTARIO HOSPITAL ASSOCIATION
January 2007
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Patient Focused and Centred