1. New Attitudes: Toward Transformative Change in Health Care

2. Today in Canada  Canada spends more on health care than most other countries  We rank 8 th out of 28 OECD countries in terms of health spending as percentage of GDP  Canada ranks 5 th in the OECD in terms of health spending per capita

3. Today in Canada  Even though spending on health has increased, many Canadians still cannot access timely care:  About 5 million Canadians do not have a family physician  Emergency department waits and wait times for elective procedures are still too long  Many Canadians have no supplemental health insurance

4. Fact-Finding Mission  5 countries: UK, Denmark, Belgium, Netherlands, France  Met with approximately 36 organizations/groups (over 75 people)  Types of organizations included:  Ministries of Health (national and EU)  National medical associations and physicians  Other providers: Hospitals, nurses, public health  Health research institutes (national and international)  Other (patient group, IT organizations)  Goal: to study the “what” and “how” of health transformation

5. Key Learnings

6. European countries organise, manage and finance health care in different ways. But the systems share some common principles: universal access to care and insurance, solidarity in the distribution of costs and a good standard of care. Netherlands Ministry of Health, Welfare and Sport.

7. UK – Key Learnings  The UK has been successful in addressing long wait times, particularly for specialty care, by:  Having strong political leadership  100% activity based funding  Using incentives and setting targets-- holding officials accountable if they are not met  Introducing “contestability” (competition) into NHS to improve performance (e.g., Independent treatment centres)  Focusing on patient flow and process management to move patients through system efficiently (4-hour wait time guarantee)  Public reporting on progress (transparency)

8. Denmark – Key Learnings  Have successfully addressed wait times by:  Activity-based funding for hospitals (50% of budget)  1 month patient wait-time guarantee, after which patient is referred to private system for care  48 hour treatment guarantee and care package for cancer diagnoses (fast track)  Municipalities manage administration of long-term care services  Greater transparency including star rating of hospitals  Adopted “clinical support” approach for IT strategy  Lab reports, prescription  Online appointment booking

9. Belgium – Key Learnings  High degree of public satisfaction with system - No waits for medical care  Equal access and freedom of choice  Independent medical practice, free choice of health care provider, fee-for-service payment, activity-based funding for hospitals  Can access specialists directly without referral  Same-day appointment with FPs  Co-payments for care: approximately 25% but with a maximum ceiling and lowered for disadvantaged

10. Netherlands – Key Learnings  Hybrid approach: private health insurance for all regulated by law with strong public statutory safeguards  Funding follows patients – everyone is equal  Wait times have been significantly reduced  No longer an issue

11. Netherlands — Key Learnings (continued)  Improving quality of services is a major priority of both health insurers and by ministry of health  Quality is a factor when insurers contract with providers  Hospital performance reports  National improvement program on professional quality

12. France – Key Learnings  Social security-style health insurance system – largely employer and employee contributions and taxe  60% of elective surgeries are perfromed in private clinics, but are paid for with public funds  The French are very proud of their system

13. Major Findings  There is no one perfect system  We can’t simply import all of the initiatives from Europe (need a “Made-in-Canada” solution)  We can use best practices and apply them to the Canadian reality.

14. Common Themes: The “What” on European Health Systems All countries visited feature:  Higher supply of physicians than in Canada  Activity-based funding of hospitals  Active use of incentives and competition to increase productivity  A public-private mix of some kind (e.g., co-payments, publicly- funded independent contractors, private insurance)  A desire for greater transparency and for patients to play a stronger role in choosing their care

15. Common Themes: The “What” (cont’d.)  All systems based on principles of Universality and Solidarity  Wait times no longer a serious issue  Governments focused on improving quality of care

16. Common Themes: The “What” (cont’d.)  Physician shortages are not an issue in Europe  Unlike in Canada, there is no debate over the role of public/private  Health care remains a political issue  Disbelief when told of the wait times facing patients in Canada

17. How changes were made in Europe  Vision is clear and political leadership solid  Wait times often the issue that forces change  “Quick wins” in the short term are important (for example, activity-based funding)  Put more power in the hands of patients to steer change

18. Lessons for Canada from Europe  There are options to improve our health system without compromising universality  Activity-based/patient-focused funding for hospitals is critical  Create incentives to improve access (e.g. competition and public reporting)  Never lose sight of quality  Invest in IT support

19. Directions for Transformation 1.Change in attitudes/culture toward patient-focused care  Understand that it is possible to transform the health care system, other countries have done it  European model rather than American  Change in attitude among physicians required (better client service)  Change in societal attitude needed

20. Directions for Transformation 2. Partial activity-based funding for hospitals  Money follows the patient  Activity-based funding can be partial  The patient becomes a source of revenue and not of cost  Accountability

21. Directions for Transformation 3.Competition and contracting out of services  Delivery of services by the private sector, but paid for by the State  France  NHS

22. Directions for Transformation 4.Incentives to support quality care/outcomes  Financial incentives for communities that succeed in reducing hospitalization rates  transparency

23. Directions for Transformation 5.Adoption of better health human resource policies  Access to primary care  Collaborative care teams  Physician assistants

24. Directions for Transformation 6.Adopt an arm’s-length health funding model  Independent agency, separate from government  Less political influence  Greater transparency

25. Directions for Transformation 7.Direct IT funding and policy first at patient-provider level

26. Directions for Transformation 8. Institute an appropriate system of long-term care Emergency Hospital Long-term care

27. “Change will not come if we wait for some other person or some other time. We are the ones we’ve been waiting for. We are the change that we seek.” – Barack Obama

28. This presentation is available at www.cma.ca