August 10, 2012 – Canada’s premiers recently unveiled recommendations to improve health care as a part of their Council of the Federation meeting. The recommendations came out of a report led by Saskatchewan Premier Brad Wall and Prince Edward Island Premier Robert Ghiz.
The report’s recommendations touch on a number of areas that CARP has been advocating for, such as the need for better and more affordable care for patients with chronic diseases and pan-Canada approaches to information sharing and benchmarking. However, the recommendations address these large health issues in a piecemeal fashion and don’t go far enough in advancing healthcare improvement. For example, clinical practice guidelines may now be harmonized for two major chronic diseases – cardiovascular disease and diabetes. The guidelines will ensure that patients are receiving appropriate care rather than facing numerous unnecessary tests and procedures that prolong results. As two of the most common chronic diseases, this is a good place to start and hopefully expands to cover all chronic disease care, but people often face multiple chronic diseases and for these individuals, it would be of great benefit for all chronic disease care to take a comprehensive approach.
The report also recommends team-based models of care where different health professionals work together to deliver care. A patient often deals with more than one health professional, so it makes sense that health professionals should work as teams with greater collaboration and communication. This recommendation adopts the 2004 Health Accord goals of greater health care coordination and increased access but it is unclear how these team-based models will accomplish this goals. Although the report mentions homecare, it does little to advance the issue of homecare past the status quo. Not only do most seniors prefer to age at home, homecare will also reduce the burden off of institutions, increasing the sustainability of healthcare delivery. As such, homecare and innovations in its delivery should inform this team-based model of care and should be a centre piece of healthcare reform.
With fears of anticipated doctor shortages, the report’s recommendations on health human resources management are well welcomed. The recommendations promote better coordination and sharing of information for better resource deployment, and although it is not made obvious, it implies the potential problem of poaching of nurses and doctors from one region to another. If the report is aiming to address this problem, it remains unclear as to how it will do so. Additionally, these recommendations are voluntary, which makes them futile unless all provinces are on board.
Bulk Purchasing Generic Drugs
Lastly, the report recommends that three to five generic drugs be purchased in bulk so that their prices are lowered by spring of 2013. Although this is a definite step in the right direction to make health care more affordable, it is a small one. All generic and brand name drugs need to be made more affordable since many seniors with chronic conditions often rely on multiple drugs, and drugs constitute one of the fastest areas of growth in healthcare spending.
Is it enough?
The recommendations are a start in addressing the needs of the health care system from its delivery to its spending. Yet, the underlying health issues could have been addressed more comprehensively. Drugs only make up only a part of seniors’ chronic care expenses, and tackling 3-5 generic drugs is hardly a bold move. Diabetes and cardiovascular disease are only two of many chronic disease seniors face. However, given that comprehensive planning requires leadership and the federal government has declined to take on this responsibility, the premieres are taking steps in the right direction, if only incrementally.
CARP will press the provinces to continue moving forward with healthcare innovation, including homecare and chronic care services and national standards of care, as we monitor the progress of this report and report back to our members.
July 2013 Update – What have the Premiers Achieved since they set these priorities?
In January 2013, all provinces and territories, with the exception of Quebec, agreed to establish a price point for six of the most common generic drugs (18 % of the equivalent brand name drug). They hope the agreement constitutes the first step towards a more strategic, comprehensive and coordinated approach to pharmaceutical management.
Although this is a start – it is obviously no replacement for the type of direction, benchmarking and reporting that had been implemented through national standards set by healthcare accords.
What Should Reform Look Like? Read “Can we Expect Better from Healthcare Reform?”
CARP is calling for an integrated continuum of post-acute healthcare that follows patients from first diagnosis or acute episode, through initial treatment, ongoing care, and through end of life needs. The current health system is fragmented and falls short of effectively and sustainably meeting health care needs.
Individual components of the health care system, such as acute care, home care, and long-term care are largely effective in treating isolated health issues, but are often dislocated from one another, failing to follow patients through the full spectrum of health needs.
Health care providers must recognize that there is only one patient or health care consumer and go beyond the individual components towards an integrated continuum of care that connects the full range of health
services to patient needs. CARP’s Care Continuum is both person centred and aims to achieve greater health efficiency and spending sustainability by integrating disconnected health silos. Click here to read CARP’s vision for healthcare reform: “One Patient”.