Contested Ground: Why innovation isn t enough. Michael M Rachlis MD MSc FRCPC LLD (Hon)

Size: px

Start display at page:

Download "Contested Ground: Why innovation isn t enough. Michael M Rachlis MD MSc FRCPC LLD (Hon)"

Ashlie Greene
5 years ago
Views:

1 Contested Ground: Why innovation isn t enough Michael M Rachlis MD MSc FRCPC LLD (Hon)

2 Toronto April 2016

3 Outline Access to primary health care is crucial for patients and health system performance Canada has very poor access We could have much better access Why don t innovations spread faster? How could we facilitate innovation with better politics? 3

4 Where is Carey Price? Delivering health services without adequate primary health care is like pulling your goalie in the first period. You score lots of goals but lose every game.

5 Access to Doctor or Nurse 100 Same-day or nextday appointment Waited six days or more for appointment % Source: 2013 Commonwealth Fund International Health Policy Survey in Eleven Countries. Question asked differently in Switzerland.

6 Specialist Appointment Wait times 6 Less than four weeks Two months or more 100 % Source: 2013 Commonwealth Fund International Health Policy Survey in Eleven Countries.

Used an ER in Past Two Years % 75 50 25 22 22 24 27 28 28 28 31 32 39 41 48 0

7 Used an ER in Past Two Years % Source: 2013 Commonwealth Fund International Health Policy Survey in Eleven Countries.

8 Doctor Can Electronically Exchange Patient Summaries with Doctors Outside their Practice % NOR NZ NETH SWE UK SWIZ FR US AUS GER CAN Source: 2015 Commonwealth Fund International Health Policy Survey of Primary Care Physicians. 8

10 With current resources Canadians could (usually): Have elective surgery within two months Have elective specialty input within one week Have same day access to primary health care

11 The Alaska Southcentral Foundation Created in the 1980/90s with devolution of the responsibility for care of some Alaska natives from the US Indian Health Service to a consortia of Alaska Native Bands 65,000 customer owners 1800 staff, budget ~ $250 Million During the past decade they have been recognized as one of the world s best health systems

14 The Hamilton Mental Health Program The Hamilton Family Medicine Mental Health Program increased access for mental health patients by 1100% AND decreased psychiatry outpatients clinic referrals by 70%. The program staff includes 22 psychiatrists, 148 family physicians, 150 Nurses and Nurse Practitioners, 20 Registered Dietitians, 80 Mental Health Counsellors, 10 pharmacists and provides care to 340,000 patients

15 Referrals to the Hamilton Psychiatric System Program Started Program Expanded

16 Toronto Arthroplasty Model Referring Physician Central Intake Assessment Advanced Practice Physio Surgeon Consult Surgery Post-Op Discharge Follow-Up Holland Centre Holland Centre and Toronto Western Holland Centre Mt. Sinai St. Michael s St. Joseph s Toronto East General Toronto Western

17 Why don t innovations spread faster?

18 There are lots of other issues but the lack effective clinical governance is arguably the biggest elephant in the room 18

19 Of the 230 Vancouver psychiatrists who see patients, what percentage said they would definitely see a referral in a timely manner? 75%? 45%? 15%? 3%? Goldner et al., 2012; Can J Psychiatry, 56:

20 What are the rules which prevent effective clinical governance? All high performing health systems have high performing medical groups and effective clinical governance but Canada s insurance model makes it almost impossible to create high performing medical groups in the community Canadian doctors should do their work very differently but it is almost impossible to pay them to do so Provincial medical associations mainly control the allocation of Medicare dollars

21 We need to change the way we deliver services 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 1982

22 Courage my Friends, it is Not Too Late to Make a Better World! Tommy Douglas (paraphrasing Tennyson)

England: Europe s healthcare reform laboratory? Peter C. Smith Imperial College Business School and Centre for Health Policy

England: Europe s healthcare reform laboratory? Peter C. Smith Imperial College Business School and Centre for Health Policy Total health care expenditure as % of GDP by country, 1960-2006 18 16 14 12