Setting the Context: The BC Health System Andrew Wray – April 8, 2013

The Plan: The building blocks The challenges The strategy What this means for improvement leaders

Federal Government Delivery for specific populations Regulation of food, drugs and devices Some aspects of public health Funding partner for Provincial delivery –Canada Health Act (1984)

Provincial Governments Administration of public insurance plan Regulation of professions Delivery of many health care services (an increasing role)

1990s Over 300 health organizations Local Health Authorities 2001 Five Regional Authorities The BC Health Delivery – An Evolving System

Ministry of Health General Responsibilities Leadership and support for the health service delivery system Health promotion and protection Aboriginal health promotion Public health planning Provincial Health Officer Performance management of the health authorities Health human resource planning Health regulation and licensing Health information systems and e-health Women and seniors End of life and palliative care Community and home support services Assisted living and residential care Community care licensing Mental health and addictions services Communicable diseases prevention and addictions services promotion Healthy living/chronic disease prevention Medical Services Plan ActNow BC HealthLinkBC BC Bedline PharmaCare Vital Statistics BC Ambulance Service End of life and palliative care Major Agencies, Boards and Commissions Health Authorities Medical Services Commission BC Patient Safety & Quality Council Patient Care Quality Review Boards Hospital Appeal Board Community Care and Assisted Living Appeal Board

Follow the Money! General Revenue Fund ($41B) Ministry of Health ($15.7B) Health Authorities ($13.4B) MSC Drugs ($1.1B) MSP ($3.8B) Physician Payment

Medical Services Commission Includes representatives of the Ministry, BCMA and health authorities Responsible for delivering the public insurance plan (MSP) Responsible for delivering the Pharmacare Plan

Regional Health Authorities Deliver health services in their geographic regions All organized differently Have a few commonalities: –Many employees/few employed MD –Both delivery and funding agenda –Accountability –Run, or contract, hospitals, clinics, health units, residential care homes, home services, etc.

Provincial Health Services Authority Covers a variety of specialty services delivered provincially –BCCA –Children’s –Women’s –Transplant –CDC –MHAS –BCAS –Etc. Shares many of the same features as the regional HAs

Private Providers Includes both insured and uninsured services Wide variety of settings/services –Most physician practices –Pharmacies –Dentists offices –Chiro/physio/etc –Residential facilities –Some hospitals

Some Blurry Lines HSSBC services Lower Mainland Consolidation

Other players - Regulatory Colleges – sets standards for professions. Associations and Unions – have huge influence on health care Federal government – major funding partner – has significant influence on delivery. Other insurance programs – WCB, extended health, etc. HSSBC – Purchasing organization – “economies of scale” HSPO – Additional mechanism for distributing finding – “patient focused funding” Universities/Colleges – training of future health professionals Physician negotiated committees

The Challenge Manage the unprecedented costs of delivering medical care while improving the quality of care from prevention to end-of-life.

BC Health Spending Growing Source: Public Accounts, Ministry of Health Services/Ministry of Healthy Living & Sport Estimates, August 2009

16 Total Provincial Health Spending: 1990 – 32% of budget or $4.8 billion 2001 – 38% of budget or $9.5 billion 2011 – 45% of budget or approximately $16 billion Rising Cost of Health Care

Improved Management Efficiency Key drivers of cost growth

in 2008in 2025 Population is aging: percent aged 75+ Source: BC Stats, People 33

Source: BC STATS, July 2008 Percentage of BC’s population over the age of 65 increases from about 12% to 25% from 2001 to Use of Services Increases as People get Older 5,079,0202,530, , , ,476

Population Segments will grow at different rates 21

The Strategy Prevention and demand management Delivery in appropriate setting High quality services Efficient management practices

Price and/or demand Community Public Health Individual Prevention Long-term Condition Management Avoiding Hospital Admissions Hospital Care RehabilitationEnd-of- Life care

Service Plan Effective health promotion, prevention and self-management to improve the health and wellness of British Columbians. –Individuals are supported in their efforts to maintain and improve their health through health promotion and disease prevention. British Columbians have the majority of their health needs met by high quality primary and community based health care and support services. –Providing a system of community based health care and support services built around attachment to a family doctor and an extended health care team with links to local community services. British Columbians have access to high quality hospital services when needed. –Acute care services are accessible, effective and efficient. Improved innovation, productivity and efficiency in the delivery of health services. –Optimize supply and mix of health human resources, information management, technology and infrastructure in service delivery. –Drive efficiency and innovation to ensure sustainability of the publicly funded health system.

Innovation and change agenda slide

Prevention Review of core public health functions Healthy FamiliesBC ActNow BC

Integration of Primary and Community Care Started with Physician Primary Care - Making family practice a more attractive option - General Practice Services Committee – improving delivery Practice Support Program Full Service Incentive Program Divisions of Family Practice CHARD – community resource directory Attachment - Has also led to Specialist Services Committee and Shared Care Committee

Building on the work in primary care Linking between primary, home care, residential care, community care, etc. Continued focus of chronic diseases, specific populations Seniors Action Plan Integration of Primary and Community Care

High Quality Hospital services Clinical Care Management – Improving Clinical Care –Implementation of best practice guidelines to improve the quality of care delivered.

Supporting Strategies

So what does this mean for making improvements?