Notes for Roy Cullen, M.P.
Presentation to Romanow-Commission - June 4, 2002
Mr. Commissioner;
· Allow me to characterize the healthcare system in Canada as follows - These are the assumptions I am working on-
-High per capita spending
-Good health outcomes (e.g. infant mortality, life expectancy, etc.)
-Inefficient (poor value-for-money)
· These are very general statements, but nonetheless I believe they reflect reality.
· In my view, we need to focus on ensuring that our healthcare system is sustainable into the future (a particular challenge given demographics and the increasing number of elderly people in Canada (and growing rapidly);
· Canadians collectively should, in my opinion, commit to the public health system (and reject 2 or 10 tier health care);
· Re-committing ourselves, however, to the public health care system brings certain responsibilities;
· We should not just throw more money at the system -that would be irresponsible and not in the best interests of citizens and Canadian taxpayers.
· Will it mean more funding for healthcare? I am sure that it will. But it will also require more than that.
· I envisage evolutionary, not revolutionary, change requiring some re-thinking, re-engineering and achieving greater efficiencies in the delivery of healthcare;
· For a period of time in the mid 1980's I worked on healthcare cost containment strategies at the provincial level and today these challenges are still with us. We need to manage the growth in healthcare spending.
· While some progress has been made in areas such as day surgery, reduced length of stay in acute care beds, and technologies, I have not seen much progress over the years in four key areas -
1. The management of the healthcare system as a continuum - from home care, through to intermediate care, to long term care and acute care, amongst others;
2. The failure to adequately address two growing and important healthcare sectors - i.e. prescription costs and the growing importance of homecare;
3. The continuing lack of focus on prevention, promotion and lifestyle factors;
4. The need for a bolder attitude when we think about the role of the private
sector in healthcare delivery (in my context within a public system), and ways
in which the users take more responsibility for their use of the healthcare
system.
Let me expand on each point.
1.healthcare system as a continuum
For years, provinces and territories have been preaching the virtues of an optimally structured and coordinated healthcare delivery system where patients receive the lowest cost care that is consistent with good patient care. The rhetoric is not matched with action, however. We still have many, many elderly patients, for example, occupying expensive acute care beds because the lower cost alternatives (like long term care or home care) is not available. This puts an incredible burden on our healthcare system and adds to patient stress. We need to have more creative ways to build capacity so that the system approaches the optimal. We will never get there completely, but we are still a very long way off. Building the lower cost capacity requires spending money today on capital or capacity building, which is difficult given the cost pressures on normal treatment - but we must do it. More creative financing, perhaps leasing instruments, may be part of the solution).
2. prescription drugs and home care
Prescription drugs and homecare are two areas increasingly taking a greater proportion of our national health care spending. Should we have a national pharmacare system? Should home care be covered under the Canada Health Act? (I was surprised when I wrote to the Minister of Health last year that home care was not covered under the Canada Health Act). There are huge costs associated with proceeding with these programs. Are we as Canadians prepared to attach a priority to initiatives such as these and, as a consequence, given scarce resources, sacrifice further tax cuts, or increases in defense spending, etc.? Choices such as this will need to be made. I hope Canadians are up to the task. The decisions are not easy ones. Frankly I for one don't know how we can talk about the importance of home care and prescription drugs not address the policy and fiscal implications.
With respect to prescription drugs, I for one support the need for twenty-year patent protection; in fact twenty year patent protection for patent medicines is a WTO requirement. What I object to is regulations referred to as the Notice of Compliance regulations. These regulations are inhibiting the ability of generic drug companies in Canada from bringing cheaper drugs to market after patents have expired. This is possible because the NOC regulations permit the large pharmaceuticals to launch often frivolous injunctions prohibiting the generics from manufacturing and distributing drugs for a period of sometimes three years. This adds a further 3 years to their 20 year patent protection, which was not the intent, and robs Canadians of lower cost drugs. This regulation should be scrapped.
3. The continuing lack of focus on prevention, promotion and lifestyle issues.
For decades, health care professions and politicians have sold the virtues of prevention and lifestyle issues. Action on these fronts, however, has not mirrored the rhetoric (e.g. cancellation of the participaction program). In fairness, it is difficult for those managing the healthcare system to set as a priority prevention, promotion and lifestyle issues, when funds are scarce for treatment alone. Collectively, we need to attach more priority to prevention, and agree on a strategy to allocate the necessary resources to these areas.
4. The role of the private sector in healthcare
In my view, we should not dismiss greater involvement of the private sector in healthcare delivery. Greater efficiencies may be possible, in my view, provided it remains as part of the public healthcare system. Medical Doctors are a current example of private for profit healthcare providers on a fee-for-service basis.
I believe that we should also not shy away from concepts such as user fees - provided there are mechanisms to ensure that Canada's poor are not denied access to the healthcare system because of cost. We hear much anecdotal evidence of abuses of the healthcare system and, properly designed user fees would, in my view, offer greater accountability and citizen responsibility.
In conclusion, I would like to convey some thoughts from two major healthcare providers in my riding of Etobicoke North, namely
· The Rexdale Community Health Centre, which does some excellent work in our area - providing services to over 10 000 individuals - many newcomers to Canada.
The Rexdale Community Health Centre supports the recommendations advanced in the submission of the Association of Ontario Health Centres to your Commission. They call on the federal and provincial governments to-
1. Renew their commitment to the four founding principles of health care.
2. Increase the utilization and funding for the Community Health Centre model as the key tool in facilitating change and improving health delivery systems.
3. Expand programs that reduce the number of low-income individuals, as poverty is the major determinant of ill health.
4. Review the current list of essential services and, in particular, look at including dental, pharmaceutical and uncovered surgical costs in that package.
5. Develop meta-strategies that set clear determinants of health goals for all government initiatives and evaluate all government programs for health effects.
Recently, I had the opportunity to meet with the Board of Directors of the William Osler Health Centre. They operate an acute-care hospital in Etobicoke North as well as to other hospitals in the area. The demands on these hospitals are increasing exponentially given the demographics in the area. This organization desperately needs continuity of funding from the province for operating budgets and capital budgets over a 3-5 year planning horizon.
I thank you and wish you the very best of luck in your important mission.