The Telegram (St. John's)
Dr. Pat Parfrey outlines ideas to improve health care
Dr. Pat Parfrey outlined eight major interventions at the Memorial University faculty of medicine’s health care forum
It is no secret health care costs are spiralling upward in Newfoundland and Labrador. An annual budget of more than $8 billion for the province is being tapped for approximately $3 billion for health care.
Dr. Pat Parfrey, speaking at the Memorial University faculty of medicine’s health care forum in St. John’s on Wednesday, outlined eight major interventions that would improve health outcomes and at the same time reduce provincial health care costs.
Parfrey is a clinical leader of Quality of Care NL and Choosing Wisely NL.
His presentation suggested a 10-year health accord that would focus on improving health outcomes.
The Quality of Care NL research has shown the half-century old health care system is providing a low value based on the exorbitant amount of money being spent on it at a time when there is greater economic stress for residents.
The percentage of the budget spent on health has to be kept in check, but at the same time there needs to be an increase in the budget targeted to social programs.
“There are many areas in health care in which processes could be streamlined to save money. Having a mechanism to appropriately monitor and evaluate current processes, and then work with those directly involved in those processes to determine the changes to be made is important,” Parfrey said. “Quality of Care NL has undertaken several projects to streamline processes and the costs savings that have been realized are in the hundreds of thousands. If mechanisms were in place to evaluate more processes, I have no doubt there would be benefits realized in cost savings, but also in the quality of care being delivered to patients.”
The accord would recommend a restructuring of the community-based care system.
It also suggests that a culture change from a demand to support for Medicare is necessary.
It also supports a national pharmacare program and suggests an independent Quality of Care Council needs to be instituted.
Parfrey said the culture change issue is problematic on many fronts. The presentation highlighted patient demand, and doctors’ practice and remuneration as key issues. In addition, it highlighted union demands, political competition and media reporting of issues, slanted to one view or the other, as being things that must be changed.
In order to find a solution, Parfrey says, the culture has to be changed to support a major provincial asset. To do so, the 10-year health accord by all stakeholders would make the
universal access to the health care system more sustainable.
The plan for innovative health care would include the adoption of successful practices in other countries, provinces and regional health authorities, as well as the better use of technology solutions, such as e-ordering.
Newfoundland and Labrador could employ some of those interventions to improve health outcomes and at the same time reduce costs he said.
“Research shows that a combination of interventions is important in facilitating any behaviour change. Other jurisdictions have used various intervention techniques with varying levels of success. However, I believe Newfoundland and Labrador is unique in that many of the players are already working together in some capacity on many common goals,” Parfrey said.
“With the right leadership and the right conversations, I believe we can come together to agree on something that works for everyone in the best interest of the province.”
Due to its small population and geographic location, Parfrey says Newfoundland and Labrador is well positioned to be a leader in health care reform by working closely with stakeholders and using state-of-the-art electronic information systems.
Excessive spending on institutional care could also be curbed by decreasing the number of
acute care hospitals by providing locally, where possible, long-term, primary and emergency care facilities. In addition, Parfrey says that combining the existing four regional health authorities into one entity would streamline systems, as well as cut down on administration costs.
“I am suggesting that we need to restructure health care in a way that puts more focus on communitybased health care,” he said. “This means fewer acute care hospitals and more community-based health care centres. This is at the heart of primary health care reform and will help address the
needs of our changing population in the most appropriate way.”
The mandate of Quality of Care NL is to ensure physicians get the right treatment to the right patient at the right time.
Their research suggests there are ways to improve upon the effective and efficient use of resources by using interventions to encourage positive behaviour change, such as practice improvement teams, academic detailing for physicians and forming a Quality of Care Council NL to oversee the changes.
This council idea was met with a vast amount of positive response. Parfrey suggests the council would fill an existing gap of monitoring and reporting on the implementation of best practices within the health care system, including Choosing Wisely guidelines, a role Quality of Care NL could evolve into with the right provincial mandate and financial support.
Pharmacare is also a big concern, as access to drugs that could be beneficial to treating a host of ailments and disease is limited, and the rapidly aging population also puts additional strains on the system.
To counter this, Parfrey supports the formation of a national pharmacare program that would decrease the cost of specialized drugs. This would increase access to drugs that may improve outcomes for the patients they are prescribed to.
Twenty per cent of the residents of Newfoundland and Labrador were over the age of 65 in 2017. Projections show that 34 per cent of the population will be older than 65 in 2038.
Life expectancy numbers show men in this province live to an average age of almost 76, while women live to an average age of almost 81.
This province has the highest health expenditure costs in the country for both hospital and secondary institutions, averaging $2,431 per capita for hospitals and $844 for other institutions, substantially higher than the national average of $1,662 for hospitals and $507 for other institutions.
“Social programs are an essential component of better health outcomes. Research suggests that by investing one cent in the social programs for every dollar spent in health care will increase life expectancy by five per cent. This equates to approximately four years of life,” Parfrey said.
“By investing in social programs and targeting youth to create positive health habits early, we are investing in the future residents of Newfoundland and Labrador, as well as taking steps towards a more sustainable health care system that has less chronic disease and illness.”