Put­ting pa­tients first can sa­ve Ca­na­da’s health sys­tem

Pa­tients First could be an in­cre­di­ble mo­ment for health sec­tor lea­ders to dra­ma­ti­cally res­ha­pe how health ca­re is de­li­ve­red in On­ta­rio

La Jornada (Canada) - - ENGLISH SECTION -

On­ta­rio is get­ting ol­der. The num­ber of se­niors has been stea­dily in­crea­sing and, over the next 20 years, will dou­ble. In­clu­ding fac­tors li­ke in­crea­sed use of health ser­vi­ces and evol­ving tech­no­logy, this will re­sult in a subs­tan­tial in­crea­se in de­mand across the health sys­tem. Tho­se ser­vi­ces will cost mo­ney.

In just the con­ti­nuing ca­re sec­tor (e.g., ho­me ca­re, rehab fa­ci­li­ties, long-term ca­re ho­mes), pu­blic spen­ding will need to in­crea­se by $16 bi­llion. That doesn’t in­clu­de an in­crea­se in pri­va­te spen­ding of anot­her $10 bi­llion.

The On­ta­rio go­vern­ment’s res­pon­se is the Pa­tients First Act, now being put in­to ac­tion. Pa­tients

First is a struc­tu­ral reor­ga­ni­za­tion of agen­cies in the com­mu­nity health sys­tem, em­po­we­ring lo­cal health aut­ho­ri­ties with more res­pon­si­bi­lity for pri­mary and ho­me health ca­re de­li­very.

How will this help ta­ke ca­re of dou­ble the num­ber of se­niors by 2037?

It’s not en­ti­rely clear - at least not yet. The­re’s a risk that this reor­ga­ni­za­tion with a friendly na­me will just shuf­fle ac­ti­vity from one branch of go­vern­ment to anot­her.

But the­re’s op­por­tu­nity for a real trans­for­ma­tion in the way we de­li­ver ser­vi­ces. Ta­king ca­re of more se­niors doesn’t ha­ve to be more ex­pen­si­ve. That’s the po­ten­tial of Pa­tients First: to re­or­ga­ni­ze the health sys­tem to treat pa­tients be­fo­re they be­co­me pa­tients and to or­ga­ni­ze ca­re around cost-ef­fec­ti­ve, com­mu­nity-ba­sed ca­re ins­tead of rel­ying on the tra­di­tio­nal, ex­pen­si­ve hos­pi­tal en­vi­ron­ment.

The­re are th­ree ma­jor ways Lo­cal Health In­te­gra­tion Net­works (LHINs) can use their new res­pon­si­bi­li­ties to dri­ve chan­ge.

First, im­pro­ve what they’re al­ready doing. We know bet­ter com­mu­nity and pri­mary ca­re can avoid ex­pen­si­ve hos­pi­tal ad­mis­sions. Yet our health sys­tem is still lar­gely or­ga­ni­zed around hos­pi­tals, whi­le the ill­nes­ses that af­fect most pa­tients are chro­nic and can be bet­ter ma­na­ged in the com­mu­nity.

That’s whe­re LHINs should start to shift the fo­cus of ca­re. For exam­ple, why not gi­ve hos­pi­tals the means and fun­ding to or­ga­ni­ze their own ho­me ca­re and mea­su­re their per­for­man­ce on re­du­cing ad­mis­sions?

The se­cond is by prio­ri­ti­zing po­pu­la­tions ac­cor­ding to tho­se who can be­ne­fit most. We know that our most so­cio-eco­no­mi­cally cha­llen­ged com­mu­ni­ties ha­ve the hig­hest ra­tes of ill­ness and the lo­west le­vels of pri­mary ca­re sup­port. LHINs should wrap fo­cu­sed sup­port around the­se areas. Why not di­rect ho­me ca­re and pri­mary ca­re fun­ding to­wards the­se com­mu­ni­ties? The third is to im­pro­ve po­pu­la­tion health and di­sea­se pre­ven­tion. Ra­tes of pre­ven­ta­ble ill­ness are hig­her than they could be. What if we fo­cu­sed on re­du­cing them? Po­pu­la­tion health is an ap­proach to health sys­tem plan­ning that fo­cu­ses on ser­vi­ces that allow us to lead healt­hier li­ves, today, to­mo­rrow and well in­to the fu­tu­re.

LHINs can use their new res­pon­si­bi­li­ties to ce­ment a po­pu­la­tion health ap­proach to all ser­vi­ces in their com­mu­ni­ties. LHINs could co­lla­bo­ra­te with pri­mary ca­re prac­ti­ces to mea­su­re and mo­ni­tor ove­rall health sta­tus, and gi­ve family doc­tors the fi­nan­cial fle­xi­bi­lity to pres­cri­be any kind of sup­port - li­ke hou­sing or in­co­me sup­ports - that re­sult in healt­hier pa­tients and com­mu­ni­ties.

In shif­ting the fo­cus of our health sys­tem to­wards pre­ven­tion and com­mu­nity ca­re, we will need to be very mind­ful of Ca­na­da’s pro­mi­se of uni­ver­sal ca­re. The Ca­na­da Health Act (CHA) gua­ran­tees that all hos­pi­tal-ba­sed ser­vi­ces must be pu­blicly fun­ded and ac­ces­si­ble to all. But in the com­mu­nity, the CHA only does so for phy­si­cian ser­vi­ces. This shift to pre­ven­ti­ve and com­mu­nity-ba­sed ca­re needs to be un­der­ta­ken with a pro­mi­se of uni­ver­sal ac­cess if we wish to crea­te a health sys­tem that will ef­fec­ti­vely ser­ve a gre­ying po­pu­la­tion.

Pa­tients First could be an in­cre­di­ble mo­ment for health sec­tor lea­ders to dra­ma­ti­cally res­ha­pe how health ca­re is de­li­ve­red in On­ta­rio - to truly reali­ze the pro­vin­cial go­vern­ment’s vision to ma­ke On­ta­rio the “healt­hiest pla­ce in North Ame­ri­ca to grow up, and to grow old.” -TROYMEDIA

Ka­pil Khim­das has wor­ked in se­nior ma­na­ge­ment ro­les in health sys­tems in Ca­na­da and the Uni­ted King­dom. He is a gra­dua­te of the Ken­nedy School of Go­vern­ment and Bu­si­ness School at Har­vard Uni­ver­sity. Dan­yaal Ra­za is an ex­pert ad­vi­ser with Evi­den­ceNet­work.ca, family phy­si­cian at St. Mi­chael’s Hos­pi­tal and as­sis­tant pro­fes­sor with the De­part­ment of Com­mu­nity and Family Me­di­ci­ne at the Uni­ver­sity of To­ron­to.

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