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An Acute Care System Living in Chronic
Care World
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Members of the
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Medical
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Genesis
The Birth of Medicare in Canada Canadas Constitution
Section 91: The responsibilities of the Federal
Government
Part 1 the right to change the Act with respect to the powers
given to the provincial legislatures.
Parts 9-13 matters related to the seas and Great Lakes such as
lighthouses, fishing, coastal boundaries and ferries between
provinces
Genesis
The Birth of Medicare in Canada
Step 1 - Medicare: Hospital focused, with a purely financial role for the Federal Government
Health Care began in the provinces, first in Saskatchewan in 1947 and then in Alberta and
British Columbia in 1950. However, this was not full health care. It pertained only to hospitals.
In 1957 the Federal Government passed the Hospital Insurance and Diagnostics Act. This
provided reimbursement (effectively, cost-sharing) for one-half of the Provinces and Territories
costs for a specified list of hospital and diagnostic services.
Context
The Birth of Medicare in Canada
The system that was designed in the 50s and
60s was designed to meet the health care
requirements of the day. At this time,
Canadians:
Lived much shorter lives
Had fewer chronic conditions (in part,
because acute health events like heart
attacks and accidents were much more
prevalent. Many more died before they
had time to acquire chronic conditions)
Smoked much, much more.
Our system was designed for an acute care
world we now live in a chronic care
world, and our system has not adapted to
meet the requirements.
Also, during this time our population moved to
the cities in huge numbers
Context
Smoking Prevalence: 1965 - 2012
1965:
62% of Men
37% of Women
50% overall
2012:
19% of Men
14% of Women
17% overall
Context
Life Expectancy and Quality of Life (1/5)
Context
Life Expectancy and Quality of Life (2/5)
Context
Life Expectancy and Quality of Life (3/5)
Since 1921:
Death before age 4 has
dropped off significantly.
Life expectancy between
5 and 74 has increased
Life expectancy over 75
has increased
significantly
Context
Life Expectancy and Quality of Life (4/5)
Context
Life Expectancy and Quality of Life (5/5)
Moderate disability and
severe disability rates are
effectively steady across
ages groups.
Functional health drops*
off significantly starting at
65 years of age. This is
happening as life
expectancy is
increasing.
* Functional health is
measured using a scoring
system based on selfreported performance on
eight key health
attributes: vision,
hearing, speech,
mobility, dexterity,
feelings, cognition and
pain.
Total: 7.0%
2.7%
0.9%
Total:
3.3%
0.9%
1.0%
1.1%
0.9%
Total:
2.4%
1.2%
2.4%
2.5%
-1.2%
1.3%
-0.9%
Total:
0.9%
2.0%
1.1%
1.7%
-1.7%
Questions?
Health HR
E-Health / IT
National Pharmaceutical
Purchasing
After Care
Surgery
Specialists:
OB/GYN
Oncologist
Respirologist
Cardiologist
Etc
Physicians Assistants
Ambulance
Doctor visit /
clinic
Interface with
Dr:
GP/Family
ER Doctor
GATEKEEPER
Prescriptio
ns
Specialized
Treatment
s
~$1600 day
(depending on
Province and
hospital)
~$200 day
(depending on
Province and care
delivered)
Summary
Todays Challenge
Cost Growth will continue: health cost growth drives options, none of them desirable:
Without reform, cost growth will continue.
As costs grow, taxes either need to go up, deficits need to rise, or Governments need
to make cuts / constrain their policy options in order to meet health care spending.
Technology is not being adequately harnessed
Individual technologies are highly effective in acute / tactical application.
We have no health enterprise system to manage records and other research
data.
Google, Amazon, Wal-Mart and every other multi-national corporation can harness
this technology. We MUST find a way to overcome the privacy issue.
The Very nature of our model needs to be revisited
Our model is still based on some aspects of the Acute model.
We live in a Chronic care world.
Aging Demographics
We are living at lot longer.
This creates new challenges for the delivery model for health care.