BC Conversation on Health A Partnership. for Health Care or Wealth Care PATIENT $ $ $ PROVIDER PROVINCE Submitted by British Columbia Chiropractic Association July 2007
Introduction The BC Conversation on Health is a process that has sought to hear from British Columbians. The challenge of this process is to determine whether British Columbians have been empowered through knowledge from school age onward to take advantage of this opportunity. Will they participate in a manner that will demonstrate the understanding that it is the patient who has the personal experience to identify the best outcomes, and should have the ability to choose the desired one? It is these outcomes that must be at the core of health planning, reform, dialogue or conversation. Reflecting on the majority of reports in BC and other jurisdictions, these outcomes are overshadowed or ignored in favor of how much more to pay for care. Demand for services is impacted by population demographics (both age and growth), and injury and illness patterns. Choice of treatment is a right of British Columbians. Science and technology themselves are small but visible cost drivers in the overall scope which invariably create new efficiencies. In addition, health personnel resources are subject to cycles and political decision making. Impacting all these topics, however, are the most important elements of all daily health services, early and correct diagnosis and importantly the most effective treatment by individual health providers. Ignoring the criteria and principles leading to outcomes has contributed to repeated health task forces and commissions with the repetitive result of squandering billions. If funding is the only focus of conversation, there will likely never be enough money and tomorrow s health care results will be the same as yesterdays. 2
Executive Summary Health care is a partnership of the public, provider, and provincial government. This partnership, above all exists first for society, and needs to respect each person s need for optimum outcomes of health care, and the personal choices and practices of individuals. The Canada Health Act is a limited participant in the province s primary role of enabling health services. The CHA s role is limited to redistribution of Canadian s taxes subject to federal criteria. This continues to be a lesser role in provincial funding and planning of health services and their infrastructure. The principles of the CHA apply for the redistribution of taxes but can also apply as comprehensive guides by which to meet health needs in hospitals and, more importantly, for all daily health services chosen by the public, the overwhelming majority of which occur outside of hospitals. The Conversation on Health must support a patient centered health delivery model and not exclusively institution based care. As well, Primary Care must be organized to support patient choice and their desired outcomes. Acknowledging and acting to support the public, as an empowered health consumer, is critical in order to realize cost savings that will sustain the decreasing public portion of Medicare. Summary Recommendations Respecting Patient Choice The success of government planning will be achieved if government awareness and action follows the Ministry of Health statement in the 2007-2008 service plan. The greatest untapped resource in health care is the consumer. Well-informed patients get better care and also assist in better prevention. The issue at hand is how to get the right information into the hands of the right person and at the right time. The development of a comprehensive self-care strategy that support not only individuals but also health care professionals will take advantage of existing resources. Education A conversation on health requires informed and empowered individuals. This must occur first at the K-12 education level. Students should be provided basic health information and empowered to make health choices. Secondly, examples of healthy lifestyles should be developed and promoted by all stakeholders to create a culture of healthy life style for all adults. Thirdly education opportunities should exist to establish teaching and research centres of excellance in BC universities. The BCCA recommends the establishment of a university based program in BC to provide education and training for those persons choosing to be chiropractic doctors. Such a program would support government planning for health manpower and future research involving centers of excellance. 3
Access In order to maximize the resources of the provincial health care system greater integration and access must be provided to all regulated health care providers. The ministry of health knows fully the cost of duplication of exams, tests, and consultations to the health care system. Allowing greater access to all public services including appropriate access to patient information by regulated professions will accelerate clinical care and reduce costs to the whole system. For example, currently a chiropractic doctor cannot refer their patient for diagnostic tests to a public facility including x-ray laboratory and hospitals for diagnostic purposes. The BCCA recommends a policy that does not discriminate against the patient based on their choice of regulated health provider Funding The Canada Health Act, section 9, Comprehensiveness, includes a reference that federal funds should be available for services from professions where the law of the province permits, which includes the chiropractic profession. The funding of necessary health services is not limited by the Canada Health Act. Health funding should broaden the range of services, rather than continue to narrow, to take advantage of services which reduce pharmaceutical costs and their dependent nature. Substantive health issues including spine and spine related conditions comprise 1/3 of all daily health care utilization. This large population problem allows opportunities to lower costs through funding policy which recognizes the economy of scale and insurance opportunity. An optimally functioning health care system will direct a patient to the most experienced and most cost-effective health professional for their condition. The current system does exactly the opposite and the potential for cost-savings is apparent. Health providers The provincial ministry of health should recognize all primary contact health providers on an equal basis to support the daily choices the public makes for necessary care. This is an absolute necessary recognition to not only fully integrate primary health care but to fully acknowledge the public s right to choose who their primary care provider will be at their time of need. From the public s choice, regulated health professions are not alternative, supplemental, or complimentary, but more appropriately, mainstream or core services supporting the public health care system. 4
A Partnership. for Health Care or Wealth Care The BC Conversation on Health represents the current chapter in the BC s history of the organization of health services. All previous reports have been in response to the same themes of funding and infrastructure. The rapid change in technology and computer related business processes have added a new dimension to planning of health systems. These however must not replace the overriding priority to ensure that outcomes must be the focus and basis for all health services whether institutional or the daily office visits to health providers which comprise the majority of all health care. This brief includes the past and ongoing assumption that the health care industry will continue to undergo a radical restructuring. The evidence for this includes: 1) Escalating health care costs each of the past 25 years 2) Increasing changes to health services from science and technology 3) Societal changes which are moving toward a "consumer" oriented system 4) An aging population The options available to government and the health professions range from preserving the status quo to an active involvement in the restructuring process. The BCCA recommends the latter strategy. We have taken the position that we are responsible and accountable to the public, the health care "consumer", for the advice and service we provide. We have recommended an approach that requires government to mandate the equality and integration of health professions in respecting the daily choices made by patients in reforming the future of health care. A priority of the Chiropractic profession in this province is to work with the other professionals, the Government and various interested parties in shaping the future of health care. The Primary Care initiative must be patient centered rather than organized around a single provider. It goes without saying that health care delivery systems are rapidly changing and need to be flexible to respond to increasing awareness of outcomes and research, which are the basis of evidence based health policy. 5
THE FUTURE In British Columbia we are experiencing a number of challenges that are reshaping the character of health care delivery. These are: 1. Escalating Health Care Costs Every year provincial budgets increase due primarily to rapidly growing expenses producing extreme government responses. Health care costs have increased dramatically over the last ten years. Historically, each profession has approached patient care with the assumption that their primary responsibility lies with providing high quality care while government should administer funding and payment for the public s needs. There is, however, segregation of funding and a serious question as to whether the funding is achieving optimum outcomes. Government policy cannot be effective without considering whether value or effectiveness is achieved. Increasing the awareness of outcomes and making this criterion a primary part of health planning will reduce unnecessary health costs. The sole privatization of the public s necessary health care will reallocate and not reduce costs. The previous limiting of profession size and income levels has obviously not dealt with much less met the current health funding challenges. 2. Empowering patients and privatization As part of the future change, individuals must be encouraged and supported to take greater personal responsibility for their own health. This will result in a more discerning "consumer" of all services. Complemented by a societal trend to more self control and less reliance on large institutions, public education and preventative measures will be of increasing importance. At the same time, this more learned public will compel government and professions to be increasingly accountable for the planning of and delivery of health services by each individual provider. 3. An Aging Population Scientific and health care advances have resulted in an increased aging population in addition to the impact of immigration to British Columbia. The increased aging population will require more health related services. Clearly, this will compound the financial pressures as well as necessary infrastructure which we are currently experiencing. There are however provincial programs such as those in New Brunswick which have begun to address health needs through solutions other than institution based care. 6
4. Other Trends and Developments Our economic and social fabric is undergoing substantial change. Examples which will impact demands on the delivery of health care services include: * trends from manufacturing to service industries * challenges of inactive lifestyles and resulting lower fitness levels * substantial loss of life, health complications arising from iatrogenic (medical) mistakes noted by federal and provincial programs * broader participation of women and minorities in the work force and in non traditional occupations * increasing demands for holistic approaches aimed at dealing with the total person, i.e. the body, the mind and the emotions to support prevention. * a trend to self help and self care. This includes taking greater personal responsibility for one's own health, habits, lifestyle and environment. CHALLENGES TO THE HEALTH CARE PROVIDERS The continued challenges can be viewed as the "seed" of the opportunity to government and all health authorities to work toward a restructured system for health care that is comprehensive in its recognition of outcomes. Alternately, it can be the "stone" of refusing to change, accepting continued higher costs and sub-standard outcomes. The clear choice of government is to lead health care restructuring through its law making and organization of services. It is clear that the issue is not an inability to pay for health care, but the method of funding patient s health. In our view then, there is no alternative. The challenges remain to be addressed and resolved as in previous reports. They must be the "seed" from which a new system can grow and develop. Strategies that will be of increasing importance include: * promotion and enhancement of good health through preventative measures. * a multi disciplinary team approach that respects the patient s choice and right to care and do what is in the best overall interest of the patient. * cost effective delivery of health care services. This will result in pressures to change many of the rigidities and interprofessional rivalries that characterize the current system. 7
* Measures to reduce dependency on costly institutional care. * Non surgical and non pharmaceutical health solutions which address chronic and degenerative problems. The BC Chiropractic Association is a partner with the Ministry of Health in providing necessary core services to British Columbians since 1934. The treatment and prevention of health conditions which utilize an estimated 1/3 of all daily Medicare, demands a strategic plan to support public health and lower health costs. The BCCA can contribute to this strategic plan in a manner which will not only reduce cost and improve outcomes, but will provide a solution to medical manpower issues. Highly expensive institutional support is not required, but government should ensure that there are no barriers to the public s access to members of the College of Chiropractors of BC in hospital and institutional health centres. In order to achieve the best overall form of health delivery, this is an essential and basic prerequisite for achieving desirable standards of care. It would be overly simplistic to state specific solutions to the problem. However, examples of areas where both cost savings and improved patient care are possible include sharing of information, facilities and professional equality. We must build on the specific strengths that each of the professions has to offer. Also, it will be our responsibility to seek out areas where cooperative research can take place. It is fundamental that this cooperation take place if the professions and the public are to make more educated and informed decisions concerning the most effective form of treatment. Today the public continues to find itself faced with an overwhelming volume of information often kept isolated or presented in a way that is far to often conflicting and confusing. 8
CONCLUSION The future of health care delivery is characterized by an increased need or demand. This is subject to the ever changing circumstances of each criteria impacting health delivery, whether planning by government or provision of services by the individual provider. The severe pressures, documented in each previous BC commission and report, are today s reality. Sustaining health delivery requires respecting patient choice and being aware of and implementing all improved patient outcome in future health planning, not fiscal policy that solely increases and reallocates health costs, often in a haphazard way as happens far to often. In the decade and beyond we will see a much better informed public that will increasingly take responsibility for prevention of illness and, when necessary, seek needed care. This will evolve into a more "consumer health care delivery system". In order for the various health care providers to be effective, it means setting aside old conflicts and voluntarily working together with government in the restructuring process. It does not mean a refusal to change. Rather, it mandates that as part of our responsibility to deliver care to our patients, we must learn how to change and how to manage the change process. We applaud the BC government s continued efforts and dedication in this ambitious undertaking. To build a more effective delivery system for the future, some of the central political and policy stances taken by government must be questioned and where appropriate and necessary, altered. It is a process that the British Columbia Chiropractic Association endorses and looks forward to being an integral part of. 9