Dr. Brian Day @DrBrianDay

Speech Delivered by Dr. Brian Day

Apr 01, 2008

Vancouver Board of Trade

Good afternoon, it is my pleasure to be here today and address the Vancouver Board of Trade, because like me, you have repeatedly pointed out the need for change and updating of our health system. I will outline some of my experiences as president of the Canadian Medical Association, and offer some thoughts on the momentum that is building - here in BC and across Canada - toward a patient-focused health care system.

The CMA is a voluntary association of over 67,000 physician-members and is the national voice of medicine in this country. Just three months younger than Canada itself, the association has grown and evolved over the years and now provides many diverse services for physicians, along with advocacy efforts on behalf of doctors and their patients.

The CMA mission is to advocate for the highest standards of health and health care for patients. We do represent a special interest group - we call them patients.

In fact, the CMA's focus on patients has never been stronger - and probably never more necessary - than right now.

Today, I will discuss how building a new and revitalized system requires action in key and specific areas of our health care system. We are making progress, but we must keep up the pressure and the momentum.

I will also unveil today a valuable new technology that will, with the click of a mouse, enhance the quality of care physicians provide to their patients.

Access

That health care costs are both significant and a serious challenge for governments is a surprise to no one, certainly no one in this room. Remarkably, we have some who even deny that costs are rising even though 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 patients and doctors, new and often expensive drugs and medical technologies, add tremendously to costs. Canadian society is going to have to make difficult choices regarding which services are to be covered by our publicly financed health care insurance. As the World Health Organisation has stated, "If services are to be provided for all, not all services can be provided". Making those choices will be a difficult, but necessary exercise.

In discussing costs, however, it may be surprising for some to learn that the inability of our system to provide timely access to quality health care services also exacts a significant cost.

Instead of having a system that works to serve patients, we have patients that are forced to work the system as they languish on waiting lists for care. There are countless examples of how patients are subservient to the system, a system that sometimes acts with astounding arrogance.

In January, the CMA released new research showing that, in addition to the human health cost and suffering, patients waiting for care also cost our economy 14.8 billion dollars in 2007.

This study examined just four priority areas targeted in the 2004 First Ministers Health Accord.

Selected for analysis were: joint replacement, cataract surgery, heart bypass grafts, and MRI scans.

The estimates in this study are extremely conservative and don't include the growing, and significant costs of waiting to see the GP or specialist.

They do not include the costs, short and long term, of the deterioration that occurs while waiting.

And, the 14.8 billion dollar figure is based on patients in just 4 clinical areas.

I want you to imagine the costs if all of these were included, in all areas of clinical care. Patients deteriorate while they wait. They sometimes develop chronic and severe irreversible damage, addiction to painkillers, and depression. It need not happen. It has to stop.

Just last month a report estimated the economic cost of mental health in Canada to be a staggering $51 billion. That's a lot of money.

Canadian taxpayers are spending vast amounts 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 - in the same ballpark as Slovenia, Rumania, and Lithuania. We came in dead last in terms of value for money.

Many countries have universal care, no wait lists and systems that cost the same or less to run as ours does. Wait lists can and must be eliminated in Canada.

How do we fix this problem? The answer is simple. Empower the patient. Change the focus to patient care.

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 need to place the patient at the centre of our health-care system.

This change needs action and leadership.

To be fair, momentum is growing and things are happening across the country.

An essential change that is now underway is a shift away from block or global budgets of institutions, in favour of instituting patient-focused, performance, or service based funding of hospitals.

This will return patients to their rightful place at the centre of the health care system by providing incentives for the system to treat them.

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.

By shifting our focus we can "bring care home" and benefit from the new health industry of medical tourism, generating major new revenues for our public hospitals and institutions. The 300,000 Canadians who go abroad for medical procedures, and the 500,000 Americans who currently go to India, Thailand, Russia and Europe, will be able to have their treatment here.

Recent health policy activities indicate growing support for the idea of patient-focused funding.

In BC, we have seen success with new emergency funding models based on performance. There are initiatives to add the principle of accountability to our health laws.

The recent provincial budget has added further resources to this pioneering effort in BC, and our government will reap the appropriate rewards through improved patient care and access.

New Brunswick today released a new health plan, with a major focus on improving access, supporting innovation and examining a shift to patient-focused care and funding.

Of course, there is also Quebec, where a task force chaired by Claude Castonguay recently released a report with some 34 recommendations and 9 "propositions" aimed at achieving a sustainable health care system.

In responding to the task force's report, Quebec announced several pilot projects and tests of the patient-focused approach.

Governments are now beginning to live up to their legal, moral, and economic duty to deliver timely care. Successful partnerships with the private sector have helped shorten wait lists in many key areas, but more work and more cooperation is needed.

We opened the Cambie Surgery Centre in 1996, right smack in the middle of a long tenure of the NDP government and since then it has been a part of the successful role of the private sector in Canadian health care. We opened in response to pressures of massive wait lists - 450 of my patients were on a list -, and rationed operating room time. My personal OR time dropped from 22 to 5 hours a week. We have helped eliminate wait lists for injured workers, and other groups. We have helped retain and repatriate health workers in BC, and we are a valuable part of the Canadian health system. We are always patient focused.

It is time to assign the private-public rhetoric on health care 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 fact is, that the private sector props up our health system now. Visit the campus at our largest hospital in BC - the Vancouver Hospital - and you will find yourself surrounded by new technologies. There are innovative clinics. Whole hospital departments, and even buildings, such as the Jimmy Pattison Pavilion, the Jack Bell Centre, and the Gordon and Lesley Diamond Centre, to name just a few that have been funded through the generosity of private philanthropists. And yes, they have been funded through the profits they and their businesses generated engaging in successful private enterprises.

Add to that the private contributions made to health care through the 80,000 charities that are, for the most part, not even accounted for when we describe 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 talk at the Empire Club in Toronto several months ago, the Registered Nurses' Association of Ontario held a conference to denounce the content of my speech - 2 hours before the speech. In so doing they denounced private insurance. They had no response to the 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.

Remarkably, I have also heard some question the BC government plan to emphasize accountability and sustainability within our health system.

Canada's physicians owe it to their patients to keep health care at the top of the political agenda.

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

The campaign stresses that 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 have been forced 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. If necessary, governments should consider partnerships with the private sector in order to achieve the necessary expansion.

Thousands of Canadians have supported the campaign through sending postcards to the Prime Minister and urging immediate action. These postcards are available at moredoctors.ca, so please consider joining our effort.

We are pressing governments to increase our capacity to train health professionals, to support research, to collect and evaluate data on Canada's health workforce, and to increase dramatically the use of electronic medical records by physicians.

In a recent survey of doctors' use of electronic medical records, 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.

IT in the Service of Health

In 1979, Dr. Myles Clough and I presented an early example of a workable EMR. We saw the future, but were a little ahead of the times.

Currently, Canada spends 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.

Patient care and safety often require us to share medical information. Without electronic records this is cumbersome, inefficient, and often impossible. We need IT to establish and track outcomes and perform measurements that will drive improvement.

Patients are ready. A recent US survey found that 60 percent of respondents want online access to their doctors, to medical records, test results and to same-day appointments.

The CMA considers IT to be a cornerstone to building a truly patient-focused health care system for the 21st century.

Today, I am proud to announce that the doctors of Canada are unveiling the first-ever made in Canada personal health record that lets patients communicate securely with their physician.

This personal health record - or PHR - operates through the mydoctor.ca portal created by Practice Solutions, which is a CMA company.

It represents a giant leap forward in the use of technology allowing physicians to register their patients to use online tools such as an asthma tracker, blood pressure tool and weight tracker.

Designed by physicians, the portal also provides secure messaging through a private channel of communication between patient and doctor.

Once registered with their physician, patients enter the secure portal and input health information for their physician to access and monitor.

The data is automatically converted into a chart displaying a patient's results over time.

While empowering patients with tools to manage their chronic conditions, the mydoctor.ca PHR portal also allows patients to stream their health data directly and securely to their physician.

This initiative is about medicine evolving to meet the needs of 21st-century patients.

It basically builds a virtual house call by taking communication between physicians and patients to the next - online - level.

Technology has a major impact on every part of our lives and it is time to leverage that in the service of patients.

The mydoctor.ca Health Portal provides a new way for physicians to give each patient the care and attention they deserve while also allowing patients to actively participate in, and be partly accountable for, their care. The chronic conditions like asthma, blood pressure and obesity are often difficult to manage and are also responsible for over 70% of health costs.

The portal is still in its infancy, but I believe physicians and patients will see the value in it immediately and that it will grow.

Conclusion

Canada's physicians believe our health care system must be overhauled to deliver efficient, effective, universally accessible health care that is second to none. The key to this patient-focused vision starts with leadership. The CMA is determined that reforms will occur, and we need governments to act and to recognize that they need help from others, including the private sector. Inappropriate wait lists in Canada must be eliminated. Other countries have achieved this, and are reaping the benefits. We can too.

Canada must address the shortage of health professionals across the country. We must become self-sufficient in terms of educating and training enough health professionals Similarly, patient-focused health care requires patient-focused tools.

Today I touched on one such tool - the mydoctor.ca health portal - that the CMA believes will forge an even stronger bond between patient and physician, while at the same time empowering patients to play a greater role in improving their health.

That our health system has 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!

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

I believe that, and I believe together we can build the best patient-focused health care system in the world.

Thank you.