Transcript Document
Fast Forward 10 Years: Health Care in Ontario
Presentation to Grey Bruce Health Services Cathy Fooks President and CEO The Change Foundation
The Change Foundation
• Established by the OHA in 1995 to support change in Ontario’s health care system • Currently $60 million endowment • First ten years spent as a granting agency • Recently evolved into a policy think tank • Two areas of concentration: health integration and quality improvement in community care
Focus on Change
• People • Health Care • Technology and Information 1) What will be different?
2) How will affect patients?
People – Aging Population, Ontario
Source: Statistics Canada
50 45 40 35 30 10 5 0 25 20
20.6
18.2
15
0-14 6.5
6.9
15-19 6.5
6.6
20-24 45.2
43.7
25-54 1996 2006 8.7
11.2
7.4
7.1
55-64 65-74 5 6.4
75+
72 70 68 66 84 82 80 78 76 74
People - We Are Living Longer – Life Expectancy (Ontario)
Source: Statistics Canada
82.7
78.3
78.1
71.8
1979 Men Women 2004
People – More Chronic Disease, Ontario
Source: Statistics Canada
2,000,000 1,800,000 600,000 400,000 200,000 0
1,810,890
1,600,000 1,400,000
1,321,367
1,200,000 1,000,000 800,000
Arthritis 692,839 843,339 Asthma 1996 2005 300,315 510,523 Diabetes
People – Five Year Survival Rate, Cancers, Ontario
Source: Cancer Care Ontario
120 100
85 98
80 60 40 20 0
Prostate 79 87 56 63 53 58 Breast Colorectal 1990-1994 2000-2004 Other 16 16 Lung
80 70 60 50 40 30 20 10 0
People – More Immigration, Ontario
Source: Statistics Canada
73.7
70.8
0.7
Other 0.9
Non immigrant 25.6
28.3
Immigrant 1996 2006
People – Increasing Levels of Education, Ontario
Source: Statistics Canada
35 30 25 20
20.6
24.4
25
15 10 5
13.6
11 8.8
0
Did not finish high school High School Trades certificate/diploma 2001 2006 19.3
26.7
College 24.7
30 University
People – Changes in Places of Work, Ontario
Source: Statistics Canada
20 10 0 50 40 30 90 80 70 60
7.1
7.1
Work at home 84.1
82.6
8.2
9.7
0.6
0.6
Work outside Canada 2001 No fixed workplace address 2006 Usual place of work
Health Care – The Budget Dollar, Ontario
Source: Ontario Government
20 15 10 5 0 45 40 35 30 25
33 42 Hea lth 17 Soc ial 12 16 Edu cat ion 21 16 10 10 Debt Ec ono mic d ev 1996 2007 13 3 4 3 2 Jus tice Gov ern ment Res truc turin g fu nd
Health Care – Components of Provincial Spending within Ontario Health Care (Public $)
Source: CIHI
15 10 5 0 35 30 25 20 50 45 40
24.7
47.1
8.6
4.3
4.4
3.2
1
1.6
1986 23.2
42.4
8.5
7.2
6.1
2.9
1.5
1996 35.6
21.1
9.9
9.4
9.3
5.4
2.1
2006
Hospitals Other Inst MDs Drugs Capital Public Health Admin
Health Care – Changes in Hospital Care, Ontario
Source: CIHI
8,000,000 7,000,000 6,000,000 5,000,000 4,000,000 3,000,000 2,000,000 1,000,000 0
7,037,675 5,968,216 1,079,487
1996
Hospital Discharges Length of Stay (days)
2006
948,858
Health Care - Care in the Community
• Pollara Health Care in Canada 2007 survey 27% of Ontarians report that they have personally cared for a family member or close friend with a serious health problem in the past 12 months.
Nationally: – 35% of 45 - 64 year-olds have provided care – 1 in 10 had to quit work to care for loved one – 41% had to use personal savings to survive during this time – 22% had to take one or more months off work – 41% reported that the result of caring for a family member or close friend had a negative impact on their mental health – 38% reported that the experience had a negative impact on their physical health – 40% reported that the experience had a negative impact on their finances
Health Care – Age Standardized Average Length of Stay in Hospital, Comparisons, Canada
Source: CIHI
SK MB QC NFL ON
0 1 2 3
6 6.3
9 9.3
8 8.9
7.6
8.2
4
1996
5
2006
6
6 6.7
7 8 9 10
Health Care – Use of Telehealth, Ontario
Source: MOHLTC
25,000
23,472
20,000
15,565
15,000 10,000 5,000 0
3,660 2003/04 2004/05 2005/06
Health Care - % of all personal expenditures on health care, Canada
Source: Statistics Canada
1999 2003 2007 4.8% 5.2% 5.5%
Health Care – Personal Expenses, $millions, Canada
25,000 20,000 15,000
12,656 15,906 20,996
10,000 5,000 0
medical 9,175 13,025 17,951 1999 drugs 2003 2007 1,265 1,653 2,234 hospital
Health Care – Ontarians in Family Health Teams,
Source: MOHLTC
1,800,000 1,600,000 1,400,000 1,200,000 1,000,000 800,000 600,000 400,000 200,000 0
1,100,000 1,400,000 1,700,000 2005 2006 2007
Health Care - After Hours Care, Ontario
Source: NPS, 2007
% Answering Yes
: • 79.7% have physician available for patient care during non office hours • 31.4% staffed clinic by physician or others in practice • 12.9% medical telephone advice with access to medical record • 25.8% medical telephone advice without access to medical record
Health Care – Use of Email by Physicians
Source: NPS, 2007
• 53.2% use to communicate with colleagues for clinical purposes • 64.9% use to communicate with colleagues for other purposes • 15.4% use to communicate with patients for clinical purposes • 5.3% use to communicate with patients for other purposes
Health Care – Local Health Integration Networks (LHINs)
• Currently, 14 LHINs in the province • Under the auspices of the LHINs: – Public hospitals (2007/08) – Mental health & addictions agencies (2008/09) – Community support service agencies (2008/09) – CHCs (2008/09) – LTC Homes (2008/09) – CCACs (2009/10)
Health Care - LHINs
• Not under the auspices of the LHINs: – Physicians – Public health – Ambulance services – Labs – Provincial networks and priority programs
Regional Health Authorities Elsewhere in Canada
• One regional Board to organize, fund and deliver continuum of services • Primary care not yet included although western provinces moving in this direction • Integrated information management systems • Will be the first to have electronic health records for all
Health Care - Performance Measurement/Reporting
• LHIN accountability agreements with government contain reporting indicators • Provider accountability agreements with LHINs contain reporting indicators • Government produces some public information • Waits time data on web for selected procedures • Not yet standardized
Technology and Info – by 2010
Source – Canada Health Infoway
120 100 40 20 80 60
95 88
0
Diagnostic Imaging 100 59 100 40 50 30 Drugs Goal by 2010 Labs Per cent Achieved by 2010 Electronic health record
Technology and Info – Electronic Health Record Software from Microsoft From the Microsoft web site: EHR •Can be accessed wherever and whenever they are needed.
•Give doctors and hospital workers accurate, timely information.
•Increase responsiveness by providing mobile access to records through devices such as Pocket PCs and tablet PCs •Enable patients to participate more fully in their own care.
•Provide greater security and privacy •Reduce costs and increase efficiency by replacing paper-based processes.
Technology and Info – Hospital Specific Info, UK NHS Choices – Central Web site in England
•
www.nhs.uk
Sort by city, table with all hospitals doing the procedure
•
Set of standardized questions including wait times, how many surgeries they do a year, mortality rates, readmission rates, scorecard information
•
Book appointments online
Technology and Info – Hospital Specific Info, US Hospital Compare, US www.hospitalcompare.hhs.gov
• •
Search on city, hospital name, procedures, quality scores, patient satisfaction surveys etc.
Also shows medicare payments and volumes by hospital
Technology and Info – Wait Times in Ontario How Wait Time Information Can Help You
You can use wait time information to find hospitals with the shortest wait for the procedure you need. You can ask your doctor if they can refer you to another specialist or hospital with a shorter wait. www.health.gov.on.ca
Wait times for small number of procedures by hospital and by LHIN
Technology and Info – Hospital Specific Info, Ontario
•
Some hospitals have balanced scorecards on their web sites
•
No central, searchable site yet
•
No standardized reporting on outcomes
Technology – Use of Robotics
• Carebots in the home • Robotic patient assessment • Robotic surgery "People want to stay in their houses but their kids have trouble looking after them. If you have a long term care type of companion which … would keep an eye on the person and talk to the person … family members could talk to the person through the robot. The robot would keep track of where the person is actually moving or if they're lying on the floor in the bathroom, has taken their drugs, has followed their normal routine.“ Alan Mackworth, UBC
Technology and Information – Mapping Human Genes
• Human Genome Project has completed mapping 25,000 human genes Results will: • Improve diagnosis of disease • Detect early the genetic predispositions to disease • Support rational drug design • Provide gene therapy
People In Ten Years – What Does it Mean?
• Older patients living longer with chronic disease • People receiving more intensive health care in their homes • Continued reliance on informal caregivers • Prepared to pay out of pocket or for extra insurance
People in Ten Years – What Does it Mean?
• Increased diversity of cultural makeup • Changed expectations about care, family roles • Higher levels of education – more informed and demanding consumer
Health Care in Ten Years – What Does it Mean?
• Greater consolidation of specialized programs, technical infrastructure as increasing evidence on volumes and quality is available • Distance to become less of an issue as technologies allow communication and care over large geographic areas • Role for smaller hospitals may change • More health care resources at home over longer periods of time (not palliative) to deal with chronic disease • More non health care resources at home to delay admission to a facility
Health Care in Ten Years – What Does it Mean?
• Not clear who will pay for things not currently publicly funded • Stronger relationship between primary care and hospitals – FHTs in the hospital?
• Much more primary care delivered by teams and non-MDs • Change in the hours of access – evenings not considered “after hours” • More reporting and outcomes measures made public
Health Care in Ten Years – What Does it Mean?
• Not sure about governance – LHINs will look different – may have more providers or services under their auspices – may have more authority • Depending upon what the LHINS look like, maybe changes to local governance as well
Technology and Info - What Does it Mean?
• Patients will have their own electronic record in their home and on their hand held devices • Provider specific real time waits (hospitals and maybe primary care) on the web (check that day) • Booking online for everything • Greater use of robotics in the community and in hospitals • Greater use of genetic information in prevention, diagnosis and treatment efforts