Dr. Brian Day @DrBrianDay

"Toward a Patient-Focused Health System"

Dr. Robert Ouellet

President-Elect Canadian Medical Association
Digby, NS

Ladies and Gentlemen: I am happy to have the opportunity to fill in for our President, Dr. Brian Day today and bring greetings from the CMA.

I may not look like Brian, or sound like Brian, but my views are very much like Brian's: We both agree that the time is now for change in our health care system.

There has been tremendous momentum for change vis-à-vis the health care system this year - much of it because of Dr. Day's efforts.

On a assisté à un grand mouvement en faveur de la transformation du système de santé cette année - en grande partie grâce aux efforts du Dr Day.

Driving that momentum is the fact that the status quo in health care is no longer acceptable to many Canadians.

Today I would like to share some thoughts on how the growing pressure for change is leading to new ideas for improving our health care system.

I would also like to discuss how our patients are looking to physicians to lead that charge for positive change.

Finally, I will share how Doctors Nova Scotia and the CMA can continue to lead on behalf of our patients to help build a health care system that is nothing less than the best.

Pressure for change

A recent Pollara poll showed that 68% of Canadians believe our health system needs a major overhaul.

Canadians want change but not for change's sake. They want and demand positive change.

In fact, those demands have begun to stimulate reforms in our health care system.

There is no doubt that the doctors of Canada have been forceful and effective in initiating reforms.

The public expects us to lead. An Angus-Reid poll released last month placed doctors - with a 94% rating - number 1in terms of the professions they respect and trust. We must build on that trust.

On that front, Doctors Nova Scotia has certainly earned the public's trust by working hard in the best interests of physicians and their patients.

The Youth Running for Fun program here is just one example of proactive work undertaken by the province's physicians.

I understand over 10 000 kids and some 175 schools now participate. And this year a French-language component was added with the translation of the "Guide du coureur" handbook.

This is a great program to get youth up and active. Programs such as this one are an example of putting our patients' interests first.

I know these efforts have been matched on the policy front as your President, Dr. Pugsley and Doctors Nova Scotia have worked hard during your recent negotiations and the recently ratified deal with government. Congratulations to everyone involved.

As they do here, health workforce shortages and costs are presenting serious challenge right across Canada.

Between 1984 and 2000, health care costs rose some 400%. In the same period, the population rose only 25%. That is unsustainable inflation.

Aging baby boomer patients, doctors and new, effective, but expensive, drugs and medical technologies, will add tremendously to costs.

When even more new - but expensive - drugs become available for common illnesses, how will we pay for them? Who will cover the costs as nanotechnology, gene and stem cell therapy, and cell and organ cloning become practical tools in medicine?

Chronic disease is rising and already responsible for over 70% of health costs.

Nationally, for those over the age of 65, 70 percent suffer from two or more chronic diseases

Growing demands will mean that Canadians will soon have to choose which services are to be covered by our publicly financed health care insurance.

As the World Health Organization has stated, "If services are to be provided for all, not all services can be provided".

This is a discussion that is long overdue in Canada.

It is a discussion out patients are demanding as they wait, and wait and wait, for timely access to care.

This year, under the leadership of Dr. Day, the CMA has pressed for the creation of a system that works for patients, not one that makes patients work the system.

Far too often patients must wait for needed health care services. Our failure to provide timely access also comes with a major cost, both medically and financially.

In January, the CMA released new research showing that, in addition to the human health cost and suffering, patients waiting for care in just four priority areas targeted in the 2004 First Ministers Health Accord, cost the Canadian economy 14.8 billion dollars in 2007.

The Nova Scotia portion of that cost alone was over $307-million last year.

These estimates don't include the growing, and significant costs of waiting to see the GP or specialist.

Nor the costs, short and long term, of the deterioration that occurs while waiting.

Just imagine the costs if all of these were included, in all areas of clinical care.

Patients deteriorate while they wait. Many develop chronic and severe irreversible damage, addiction to painkillers, and depression. This creates more chronic illness. It need not happen. It has to stop.

That may not be news, but that too is reality.

We spend a lot of money to limit access and keep people waiting. We pay to prevent patients getting better. The prevention of patients getting better is not what doctors mean when we talk about preventative medicine.

Wait lists can and must be eliminated in Canada. The momentum to do just that depends empowering patients and a shift to patient focused care.

Leading Change

To repeat, CMA believes we need a system that puts patients first. Doctors and other health care professionals think this way. It's time the system worked that way.

This change needs action and, most of all, leadership.

We must eliminate block funding or global budgets of institutions, in favour of patient-focused funding, where funds follow the patient. Block funding blocks access.

This idea has received broad support by the Castonguay Task Force in my home province of Quebec. And by Senator Kirby but also in BC, NB and elsewhere. And by the Organisation for Economic Co-operation and Development. And by the CMA.

Several provinces have either committed to testing it, or are studying the idea.

In England, the National Health Service has been transformed in the last 4 years. They introduced patient focused funding. They have eliminated wait lists. Patients have been empowered.

Building incentives to treat patients returns them to their rightful place at the centre of the health care system.

The OECD has stated unequivocally that patient focused funding will increase productivity and reduce wait lists, even in primarily government operated systems - and even in rural hospitals.

Governments have a legal, moral, and economic duty to deliver timely care. The aging baby boomers are informed, active, and impatient. They will not want to wait, nor should they.

We must become more patient focused, and less focused on the private-public "faux debate". This is a debate that is not based on fact, but ideology.

The private sector props up our health system now.

Physicians must continue to cut through the political rhetoric. Our patients are counting on us to keep health care at the top of the political agenda, here in Nova Scotia, and across the country.

Our patients deserve a health care system that is nothing less than number one. Nothing less than the best. That should be the goal for our health system.

The CMA and Doctors Nova Scotia are leading by example and advocating for just such a system.

Best of Change

This year, the CMA's launched the "More Doctors, More Care" campaign to press politicians into taking action. We want a patient-focused system that is accountable, effective, efficient and sustainable.

We cannot achieve that without enough doctors. We are 26,000 doctors short of the average in developed countries, and we now lag behind at 24th in the world in the number of doctors per population. In 1970, we were 4th.

Fifteen hundred young Canadians are going to medical school in foreign countries. These are "A" students, Canadians, who had to leave the country for their medical training.

In the short term, we need to encourage them to come back to Canada. In the longer term, we need to expand capacity and create new medical schools.

To date, 25,000 Canadians have supported the "More Doctors" campaign by sending postcards to the Prime Minister. These postcards are available at moredoctors.ca, so please consider joining our effort.

Canadians see how important this issue is. In fact, a poll done for the CMA by Ipsos-Reid and released just last week showed that 86% agree that there is a national shortage of doctors in Canada.

And, 89% said that the doctor shortage ranked second only to the economy as an election issue.

Beyond addressing health workforce issues, the "More Doctors. More Care" campaign is also calling for more use of information technology in health care.

Investing in physician office automation will improve the flow of information, and will lead to improved productivity, improved research data, and better care of patients.

We should be ashamed that we only spend a third of the OECD average on IT in our hospitals.

Canada's poor record in avoidable adverse effects and hospital deaths is, in part, due to the absence of available information in a timely manner. We must document, measure and analyze all data relating to hospital, physician, and patient services.

Also, government held data on hospital performance and quality must be made available to us and our patients - as it is in many countries. Patients are entitled to access such data, which is available but being withheld.

The CMA recently launched the first-ever made in Canada personal health record which, operates through the CMA's mydoctor.ca portal.

This represents a giant leap forward in the use of technology.

Similarly, your efforts here to get important new funding to support physician adoption and maintenance of electronic records systems will prove to be an important part of your new fee agreement.

Efforts such as this and so many others show our true strength as we work together and at the provincial and national medical association level.

The CMA and Doctors Nova Scotia are united in that belief and I want to acknowledge and thank my Nova Scotia colleagues for their work in pressing the cause.

I especially want to thank CMA Board members Drs. Mary Doyle and Rhonda Church. Their efforts to get it right on governance at CMA have been very helpful!

I would also like to thank all of the other committed colleagues from Nova Scotia who serve on our CMA councils and committees. These efforts in support of our members and their patients are greatly appreciated.

To conclude, I want to reflect on some of the internal affairs of the CMA.

We truly share a symbiotic relationship, based on mutual respect and support.

This has always been the case, of course, going back over 140 years when Nova Scotia's own Sir Charles Tupper served as the CMA's first President.

As I prepare to follow in Dr. Tupper's footsteps, I think of the amazing changes that have occurred since his day, even changes within the CMA itself.

In fact, this year the CMA's governance review project examined this progress and set out with the goal of improving responsiveness and representation at CMA.

In just slightly over a year, the governance review task force gathered input from about 3,000 physicians through a number of meetings, online and other consultations.

As one can imagine, there is no perfect governance model, but just last week the CMA Board of Directors unanimously endorsed a set of governance recommendations to make the association more agile and more representative of the country's physicians. I am told that subsequently, the Board of Doctors Nova Scotia also endorsed the solution.

As a member of the CMA Board of Directors and president-elect, however, I am pleased with the effort to strike a good balance. To come up with a model that is fair, constructive and respects the needs and wishes of all provincial medical associations.

It's important to note that this review wasn't a cost-cutting exercise, but a representation-building one. I believe the model proposed moves the CMA toward exemplary governance processes and structures.

I think it will give us a solid foundation from which we can advocate together for the changes to the health care system our patients need so critically.

Specifically, a system within which we can deliver efficient, effective, universally accessible health care that is second to none.

Conclusion

In closing, governments must recognize that inappropriate waiting lists can be eliminated in Canada and that not doing so costs Canadians a great deal in both human and economic terms.

Canada must become self-sufficient in terms of educating and training enough health professionals No longer can we dismiss the repeated studies that show Canada is performing poorly.

They can't all be wrong.

We are not performing nearly as well as we should and that is unacceptable.

But the physicians of Nova Scotia, working with the CMA, can - and have - made it clear to our politicians that inertia, and resistance to change, will not be tolerated.

This is a message we will keep delivering on behalf of our patients.

It is also a message I pledge to take up when my term as CMA President begins at our Annual Meeting in Montreal.

C'est un message que nous continuerons à répéter au nom de nos patients.

C'est aussi un message que je m'engage à reprendre lorsque mon mandat à la présidence de l'AMC débutera durant notre assemblée annuelle à Montréal.

I invite the physicians of Nova Scotia to attend this rendez-vous and I look forward to seeing you there.

Since I am filling in for our President, and I feel it is fitting that he should get the last word Dr. Day likes to remind people that last fall, our Governor General described Canada as the greatest country in the world.

Dr. Day also adds though, that to be the best country in world, we need a truly patient focused health system. We want more than a good health system.

We want to be number 1 - only the best should be good enough. I think we can all agree on that. Thank you.