Consultation - Collaboration - Cooperation Who We Are and What We Do A Collaborative Approach to Healthcare and Public Health in the Pacific North West Wayne Dauphinee Executive Director 2013

Pacific NorthWest Border Health Alliance Canada and US Health Systems: 30K View CA-US Pan Border Public Health Preparedness Council Note: What you see on the following slides is not necessarily what you will hear as they were prepared primarily for post workshop reference

A non-profit organization, the PNWBHA’s mission is to promote public’s health preparedness. The Alliance works toward this mission through its activities in seven essential areas: Disease epidemiology and surveillance, including food security Emergency management and public health preparedness Indigenous health Emergency medical services Public health laboratories Risk communication Public health law The PNWBHA was founded in 2009 and is a member of the Canada-United States Pan Border Public Health Preparedness Council (PBPHPC)

 PNWBHA promotes public health preparedness by actively working to:  Advocate the development and implementation of public preparedness policy;  Facilitate the sharing of health and related information;  Cooperate regionally, nationally and internationally with other organizations to promote public health preparedness;  Encourage governments to provide sufficient resources for disease prevention, surveillance and the promotion and protection of the public’s health  Advance opportunities for professional development.

British Columbia Alaska Saskatchewan Washington Oregon YukonIdaho Montana

Core Co-Chair (Canadian and United States representatives) Signatory Representatives Expanded Working Group Leads Liaison Representative from the Public Health Agency of Canada Representative from United States Department of Health and Human Services

PNWBHA’s future direction is focused on sustaining and building current efforts to strengthen public health preparedness. This includes: 1.Providing a community of practice where public health preparedness stakeholders from throughout the Pacific Northwest can come together to engage in dialogue on public health preparedness issues 2.Coordinating and supporting the extension of existing arrangements for: information sharing and protection; cross border movement of healthcare personnel and resources: and sharing public health laboratory capacity, throughout the region 3.Developing, disseminating and maintaining a map of the public health and healthcare infrastructure in the Pacific Northwest, including an emergency response capability index What is PNWBHA’s future direction? 2012

Challenge Differences in epidemiological case definitions, communication systems and professional licensure are among the issues that must be resolved in order for provinces/territories and states to enhance cross-border public health emergency preparedness and response.

Approach The Canada – United States Pan Border Public Health Preparedness Council (PBPHPC) is comprised of health department/ministry representatives from the three regional border health collaboratives (Eastern, Great Lakes and Pacific NorthWest); four unaligned provinces and states (Alberta, Manitoba and North Dakota); and the Canada and United States federal government

Authority The PBPHPC draws it authority from the November 2007 trilateral public health MOU entitled “Declaration among the Department of Health and Human Services of the United States of America, the Department of Health of Canada, the Public Health Agency of Canada and the Ministry of Health of the United Mexican States”. Mandate The mandate of the PBPHPC is to facilitate regional pan-border public health preparedness collaborations to collectively strengthen capacity at all levels to address all nature of public health threats, including: responding to severe or novel outbreaks of infectious disease; augmenting disease surveillance in the face of an evolving or yet-undefined threat; or a need to address non-urgent public health issues that arise, e.g., transportation of infectious disease samples across the border.

Goals and Strategic Priorities PBPHPC activity is chiefly focused on: Providing a forum for facilitating pan-border emergency preparedness collaboration Promoting local and regional collaborations in emergency public health activities. Ensuring all pan-border activities are deliberate, realistic and value added for all members. Addressing Federal issues that are common to all Canada – U.S. cross border health collaborations and require resolution at the Federal level. Engaging other pan-border stakeholders when appropriate to assist regional alliances and activities across the border; and Avoiding duplication of established initiatives and alliances across the Canada – U.S. border

Our Health Systems A 30,000 Foot Perspective

UNITED STATES A mixed private/public system. Largest public (and private) spender in the world but with identified gaps in coverage. Employer based coverage for many. High administrative and legal costs. Federal government provides funding through Medicare, Medicaid, SCHIP, and the VA Fast adopters of new technology for those with good coverage. Pockets of excellence in health management. Per capita spending was USD $4,271 Life, liberty and the pursuit of happiness CANADA A mix of public (70%) and private (30%) funding Universal public coverage for hospital and physician services Employer based and supplemental gov’t programs for other health services. Low admin and legal costs. Majority of health funding is provincial with some federal government providing some funding with conditions. Slower adopters of new technology. Per capita spending was USD $1,939 Peace, order and good government Health System Overview

Acute Care System Primary Care System Public Health System Public health is part of the overall continuum of health efforts Core functions of disease prevention and control, health protection and health promotion, supported by surveillance, research, policy and legislation, and human resources Includes a wide range of activities, from school vaccine programs, to anti-tobacco advertising, to emergency preparedness and response Public Health in Canada

Typical Provincial Health Funding Income Source Allocation

Typical Provincial Health System

Service Delivery Typically Who Pays for What What Payer CanadaUS Individual Province (Insurer) Co-InsurerIndividual Insurer/ Co-Insurer State Medically Necessary Services 1 Public Health Dental Optical Prescription Drugs 2 Physical Therapies Ambulance 1 Physician and diagnostic services and inpatient care, including all required drug and therapies 2 Income based Pharmacare

How We Are Organized Washington

British Columbia

Typical Regional Health Authority

Consultation – Collaboration - Cooperation 2012