Dr. Brian Day @DrBrianDay

"Toward a Patient-Focused Health System"

Dr. Brian Day

President
Canadian Medical Association
Toronto

Good morning.

Ladies and Gentlemen: It is my pleasure to be here today. Thank you all for the opportunity to speak with you.

As I have traveled across Canada to speak with our colleagues these past eight months, I have noticed a growing momentum for change in the health care system. Driving that momentum is the assertion that the status quo in health care is not acceptable. As Ronald Reagan once said, "status quo" is Latin for the mess we are in.

Today I would like to discuss some examples of how the growing momentum for change is overcoming the barrier to reform in our health care system.

I will talk about how this presents a unique opportunity for the CMA and the doctors of Ontario to step up our advocacy efforts as never before. Nothing less than number one. Nothing less than the best. That should be the goal for our health system.

Everyone in this room recognizes that health care costs are a significant and serious challenge for all governments and citizens.

Remarkably, we do have some who even deny that costs are rising. The facts are plain. There has been a 400% rise in health costs between 1984 and 2005, with just a 25% rise in population (2005 dollars). That is unsustainable inflation.

Demographic pressures of an aging population of baby boomer patients and doctors, and some of the new, effective, but expensive, drugs and medical technologies, will add tremendously to costs.

New drugs are now available that cost up to $700,000 a year to fund. So far, they are mostly for rare diseases. What will we do when effective drugs of that price become available for common diseases? Who will cover the costs as nanotechnology, gene and stem cell therapy, and cell and organ cloning become practical tools in medicine?

For just one example in my specialty, knee replacement, the numbers being done are projected to rise by 670 % within 18 years.

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".

The doctors of Ontario are to be congratulated for building the "Campaign for Healthier care" to get the critical issues facing Ontario patients front and centre.

It is an example of the patient-focused approach to renewing health care that the CMA is also promoting.

Too often, instead of a system that works for patients, we have patients that are forced to work the system as they languish on waiting lists.

At the CMA's Taming of the Queue conference last month, we sat in silence as an emergency doctor told the story of 4 patients dying in his emergency department waiting room in one day.

We heard of the general surgeon who had to cancel surgery on 6 breast cancer patients in one month. Those in charge should be relieved that there aren't riots in the streets. Canadians are too nice.

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 cost here in Ontario alone was over $6.3-billion in that 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.

Last month a report, published in Chronic Diseases in Canada, estimated the economic cost of mental health in Canada to be a staggering $51 billion. Equal to a third of Canada's total health budget.

We are spending vast sums of money in order to limit access and keep people waiting. We are paying to prevent patients getting better. The prevention of patients getting better is not what doctors mean when we talk about preventative medicine.

A study released last month by the European-based Health Consumer Powerhouse, comparing Canada's health system to 29 European countries, ranked us 23rd overall - alongside countries such as Slovenia, Romania, and Lithuania. We came in last - 30th out of 30 - in terms of value for money.

Many countries have universal care, no wait lists, and cost the same or less to run as ours does. Wait lists can and must be eliminated in Canada. The momentum to do just that depends on the empowerment of patients and a shift to patient focused care.

The CMA believes we need what some have called a "Copernican revolution" in health care.

Just as Copernicus, and later Galileo, proved that the Earth wasn't the centre of the universe, so must we develop a model where the system revolves around the patient, not the other way around.

Patients have been the "Pluto" of the solar system - hardly even considered a planet. We must reposition them at the centre of our health-care system.

This change needs action and leadership.

We must eliminate block funding or global budgets of institutions, in favour of patient-focused funding, where the funding follows the patient. Block funding blocks access. This idea has received broad support by the Castonguay Task Force in Quebec. And by Senator Kirby. And by the CMA. And by the OECD.

Two weeks ago, at the Taming of the Queue conference in Ottawa, Carole Heatly, CEO of Kingston Hospital Trust in London, England described the transformation in England over the last 4 years. They introduced patient focused funding. They have eliminated wait lists. Patients have been empowered.

In England, a consumer mentality in hospitals has led to efficiencies and improvements through the introduction of competition within the public system. Specialists' wages have risen over 20% and GP's 35%. A patient is now a value to an institution, and so are their doctors and nurses.

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

The Organisation for Economic Co-operation and Development 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.

Because of our efforts, we are already seeing results.

In BC, we have seen success with new emergency funding models based on performance and, just weeks ago, BC announced major funding for the introduction of patient focused funding.

Quebec, Alberta, Nova Scotia, and New Brunswick are planning major new reforms.

Here in Ontario, the Ontario Hospital Association has also endorsed patient focused funding.

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.

Successful partnerships with the private sector have helped shorten wait lists in many key areas, but more work and more cooperation is needed. Our Cambie Surgery Centre in BC has performed contract work for the BC government and the WCB, and has become a part of the health system there allowing waits to shorten and access to improve.

We have also helped retain and repatriate health workers in BC. We, and others, have become a valued part of the Canadian health system.

We are always patient focused.

Focus on the patient is also emphasized in the initiative of Ontario's doctors and their Campaign for Healthier Care.

The private-public rhetoric on health care must be relegated to its true and deserving place in Canadian health policy. It is a relic of tedious and tiresome propaganda and falsehood that is undeserving of debate.

The private sector props up our health system now. Philanthropic efforts fund many, many, capital projects in health care. Private contributions made through the 80,000 charities are, for the most part, not even accounted for when we calculate health costs in Canada.

Canadians know that a vibrant economy and a successful business culture are absolutely necessary if we are to fund health care and other social services.

When I gave a speech at the Empire Club in Toronto several months ago, the Registered Nurses' Association of Ontario held a press conference to denounce what I had said - 2 hours before I actually spoke! In so doing, they denounced private insurance.

They had no response to my observation that their website advertised multiple levels of private health insurance for themselves and their members! In fact, 70% of Canadians have private insurance that covers many medically necessary services. Tommy Douglas would not be happy to observe that 30% of Canadians receive a lower tier of health care than the rest.

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 Ontario, and across the country.

We need people and technology, acute care and home care, e-records and top-notch facilities, and more.

The CMA and OMA are united in that belief. I want to acknowledge the efforts of Ontario physicians such as CMA Honourary Treasurer Dr. John Rapin, Board vice-chair Dr. Larry Erlick and board members Drs. David Bach, John Tracey, Greg Flynn, Deborah Hellyer and, Suzanne Strasberg.

Dr. Ian Warrack, as Chair of the Board of CMA Holdings, and Dr. Renwick Mann, as Chair of CNMO, are making enourmous contributions.

And I would also like to thank all of the other committed colleagues from Ontario who serve on our CMA councils and committees.

The CMA's "More Doctors, More Care" campaign is designed to provoke politicians into taking action. We want a patient-focused system that is accountable, effective, efficient and sustainable.

Such a system can't exist 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 return (most don't), but in the long term, we need to expand capacity and create new medical schools.

Here in Ontario, you have pressed the case that the province is short 2000 doctors and would lose another 2500 if those of retirement age actually retired. Two days ago I spoke in Washington DC, to a group of physician leaders and US politicians. Let no one be misled. The next US President will have to address the 47 million uninsured there. As the 47 million become insured, and gain access to physicians, recruitment efforts aimed at Canadian doctors will grow massively.

Many thousands of 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.

As we look to the future, the role of technology must not be ignored. However, in a recent survey of doctors' use of electronic medical records in 8 developed countries, Canada came in last.

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.

Without electronic records, the ability to share medical information is cumbersome, inefficient, and often impossible. We need IT to establish and track outcomes and perform measurements that will drive improvement. In addition, 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 first-ever made in Canada personal health record which, operates through the mydoctor.ca portal, represents a giant leap forward in the use of technology. The massive burden of chronic disease in Canada, will be helped greatly by this initiative.

This initiative of Practice Solutions is being watched by several US software giants.

As the OMA has said, we haven't made enough progress in this area. We've lost valuable time, and continue to fall behind. Canada should aim not just to catch up, but to become a leader in this field.

I believe there is a growing momentum to overhaul our health care system so that we can deliver efficient, effective, universally accessible health care that is second to none.

The famous robber, Willy Sutton, said that he robbed banks because that's where the money was. Ontario, with its concentration of population, medical manpower, and other resources must be at the forefront of needed reforms. The OMA will have the strong support of the CMA as they continue to lead and provide the momentum for change.

Looking forward, failure is not an option. I predict that we will succeed. The commitment of Ontario's doctors and the leadership shown by Dr. Willet and many of you, will help us achieve that success. I know this leadership will continue under Dr. Arnold.

Governments must recognize that inappropriate waiting lists can be eliminated in Canada. Other countries have achieved this, and are reaping the benefits. Canada must become self-sufficient in terms of educating and training enough health professionals

Patient-focused health care requires patient-focused tools, such as the electronic health record.

For our health system to be ranked at the bottom when compared with 29 European countries in value for money, must be a wakeup call. Rising costs, together with economic data that shows we are actually paying to keep people on wait lists, should be a wakeup call.

The massive shortage of doctors in Canada, in part caused by misguided government policy is yet another wakeup call. So let's wake up!

We cannot continue to ignore and dismiss studies, such as those of the WHO, the OECD, the Commonwealth Fund, and the European Consumer Index, that show Canada is performing poorly. They can't all be wrong.

What we can surely say, with some certainty is that we are not a top performer.

Last fall, our Governor General said Canada is the greatest country in the world.

Our goal must be to build the best health care system in the world: one that is truly patient focused. One that is second to none. We can do it. You can make it happen.

Thank you.