Monday, October 12, 2009


Survey Introduction

Laying the foundation for legislative reform

A message from the Minister's Advisory Committee on Health

Alberta's health system is governed by a complex web of legislation, regulation and contractual agreements. Some of our legislation dates back to the early 1900s and has become a barrier to improved care and innovation. (The legislation was a deliberate barrier protecting against privatization!)

That's why the Minister's Advisory Committee on Health is examining what an effective and responsive legislative framework could look like in today's – and tomorrow's – context.
Alberta's health system needs to better consider a patient-centred approach that places wellness, good health and the prevention of avoidable illness and injury in the forefront.

We need support for a broader array of health providers and health care settings. We have new care facilities, new health providers, new technologies, and new ways of providing care – Alberta needs renewed legislation that keeps pace. (New Health Care Providers are US style insurance companies on the march into Alberta and Canada)

Legislation can be a tool for transforming our health system. So how can we reshape our legislation in order to put the focus on wellness? How can it help us put patients' needs first? How can we capture the best that innovation can offer? And how do we do that while respecting and complying with the Canada Health Act and our desire for a publicly-funded, patient-centered system? (They have told us they intend to change the Canada Health Act so it conforms with their ideas of private medicine practice and coverage!)

Survey guide
• Please read the following guide before completing the online survey.
The need to update health legislation in Alberta (And in Canada!)

The Minister's Advisory Committee on Health met on two occasions to discuss what principles and themes a new health legislative framework should address. As a starting point, we would like to offer the following thoughts and ask for your input.

Albertans value a strong public health system. They want to know that they can access health services when they need them, regardless of income. They want a health system that delivers services in better ways and uses technology to improve outcomes. However, today's system has legislative and regulatory barriers that limit choice and prevent change. (Again, shylocks using verbiage to do away with the Canadian standard for health in a public system!)

For example:

• A funding structure that pays for prescription drugs in a nursing home but not in an assisted living or home setting;
• Barriers to enabling health providers to use all their training and competencies, for example, in primary care settings; (stopped now by funding and soon to allow hospitals to take on US patients in our hospitals!)

• Models that firstly fund and focus on care in hospitals and secondly at home or in the community; and (Take a lien of your home before treatment is offered)

• A fee structure that makes a routine prescription renewal a medical event rather than something done by a pharmacist. (Have you ever put up with the half hour lectures and arguments by a pharmacist to get even a physician prescription filled?)

This arises because historically, health legislation – and the system – has been organized primarily according to specific facilities or settings (e.g. hospitals, nursing homes, etc.) or providers (e.g. physicians) and focused more on the treatment of disease and injury than on wellness and prevention. (The structure of the legislation has been set up to stop publicly funded and built institutions from being used by private coverage to treat their patients-as in the case of looking for US insurance business for their Cardiac and other converges; Canada hospitals are public funded and cheaper than the comparable US hospital. Canada would be a savings for US insurance)

Today, we see health in a broader social context, more in line with the determinants of health as laid out by the World Health Organization, namely, that the things that make people healthy or not include their income and social status, education, physical environment, social support networks, genetics, access and use of health services, and their gender.1

Health legislation for the future must support this broader perspective and key transformations underway in health and health care. It should also encourage innovation and allow for the adoption of new technology and practices as they emerge. It needs to help us address the challenges before us. (As in MRI units built across the province and no staff hired to run them while keeping up waiting lists to foster dissent in the population!)

Challenges to the health system
Our health system needs to be structured to meet the challenges that lay ahead. These include:
• An aging population – Today's boomers will be tomorrow's seniors and will bring profound and enduring economic, social and political implications. The first baby boomers will reach age 65 in 2011. By 2031, it is projected that one in five Albertans, or 20 per cent of the population, will be seniors. This aging population will bring greater and greater demands on the health system.
(Seniors have proven to be in better general health than the average 40 year olds in the US and Canada)

• Population growth and diversity – As of June 2009, Alberta continues to have the highest year-over-year growth rate in Canada as a result of its high birth rate and continued interprovincial and international migration2. Alberta's aboriginal communities are also growing and experience higher than average rates of certain chronic diseases, particularly diabetes, renal disease, heart disease and mental illness. Furthermore, these communities experience access barriers to the health system due to cultural, social and financial factors. (All problems brought on by the unteathered and unplanned expansion of the tar sands)

• Health spending – Alberta has consistently spent more than the Canadian average on per capita and annual growth in health spending3, yet only has average outcomes in areas such as wait times and health service quality4.

Therefore, it is unclear if we are getting value for our spending in Alberta's health system. (There has never been an itemized accounting of health care expenses in this province! At the same time hospitals have been blown up. Built and not used and huge salaries paid and even larger settlements given to changing regimes. Multi Billions squandered by this Government is not health care it is mis management)

• Impact of chronic disease and injury – The incidence of chronic diseases, such as cardiovascular disease, cancer, respiratory illness, mental health disorders and diabetes, are rising and account for 60 per cent of the health system's medical costs5. In Canada, the current cost of illness, disabilities and death due to chronic disease is $80 billion annually(Figures consider time lost at work etc not direct costs to health care)

6. Injuries are the leading cause of death for Albertans aged 1–44. Managing chronic disease and injury prevention is not solely a health system issue and requires collaboration across governments and all sectors of society. (Studies have shown much of the chronic ailments stem from sedentary life styles; lack of exercise)

• Dependency on facility based care – The majority of Alberta's hospitals and long-term care centres are operating above capacity and are not always the appropriate setting for the patients for which they are caring. However, the system is unable to readily transition patients out of these facilities and into community based care alternatives where appropriate because there is limited capacity available. (Ongoing short funding has caused bed closing which in turn lowers the capacity of the hospitals. Quirky numbers being used)

• Increased utilization of health technologies – Technologies are developed to solve a problem and improve quality of life. They are an indispensable component of the health system in prevention, diagnosis and treatment of disease and disability.

They also have the potential to be effective in avoiding health system costs, but only if used appropriately. Policies for the selection and management of new technologies must be based on scientific evidence and best practice; otherwise, health technologies can quickly become a significant cost driver while not necessarily providing for better health outcomes. (Here we go folks; they will take your house before you get a new treatment!)

• Supply and diversity of our health workforce – Health is labour intensive; in fact, Alberta Health Services spends over 70 per cent of its budget on staff salaries.(Again there is no accounting of spending-Massive severance packages come under salaries)

By the year 2020, it is projected that Alberta's health system will not have enough nurses or family physicians to meet the needs of the population. While strategies are needed to increase supply in these areas, consideration of the expanded role of other health providers is required. (An introduction into nurses union busting)

Over the past two decades, Alberta has seen a significant increase in the diversity of health professionals, such as respiratory therapists, nurse practitioners, paramedics and mental health workers. These highly educated professionals potentially could take on a larger role in the provision and coordination of health services through expanded scopes of practice. (Alberta has forced a system of reference onto Physicians. The physician refers you to a specialist and gets extra coin as does the specialist. The specialist refers patients back to the physician again for more bucks)

• Insufficient emphasis on public health – Public health is the collection of programs, services, policies and regulations that together focus on keeping the whole of the population healthy. Currently, more emphasis is placed on improving the health care or healing system rather than focusing on activities that keep us from becoming sick or getting sicker. (We do not need a private system to exercise more and eat better!)

• Limited health literacy – Health literacy is the ability to access, understand, evaluate and communicate information as a way to promote, maintain and improve health in a variety of settings. It is an essential step in managing and advocating for one's health. Research indicates that persons with limited health literacy skills are more likely to skip preventative measures, making them more susceptible to illness, higher rates of hospitalization and ultimately, higher health care costs. Strategies such as engaging health providers to assist in educating patients and early health emphasis in schools have increased health literacy. This results in improved maintenance of one's health, lower rates of hospitalization and ultimately, lower health care costs.

A discussion about principles for renewed health legislation

As Alberta's health system evolves and adopts new ways of delivering care and models that put patients and their families at the centre of their care, what principles need to be embedded or maintained in order to ensure that we protect and sustain what matters most in our health system?

In its Terms of Reference, the Committee was given two principles as a starting point for its deliberations –

1. The public health system will serve the interests of all Albertans regardless of their ability to pay; and (Ability to pay key here- if you make more than 20,000 per year you have enough to pay your own in health care- enter private insurance)

2. Access to publicly funded health care services will be fair and effective. (This means limited, fair in the Conservative world means your income is 20,000 or below!)

Another way of describing those principles is patient-centered, publicly-funded and accessible. Albertans along with other Canadians value the national framework of health services available on the basis of need, not ability to pay, linking provincial health systems with the principles in the Canada Health Act. What about quality and safety as principles? A focus on wellness? (Again the deceit :Talk Canada Health Act as it is now then, change the Canada Health Act! If there was any honesty they would tell us what exactly they want to change in the Canada Health Act and, what they want to delist in services! Ability to pay means in the final form they take a lien on your home if you do not have private insurance. Just look to the US system they are trying to emulate!)

As a starting point, we need to ask ourselves what might the guiding principles for a new legislative framework be? Do the principles below provide a starting point? What other principles need to be embedded in a new legislative framework? What would you change or add?

Examples of principles
1. Publicly funded and consistent with the Canada Health Act, including the principles of public administration, comprehensiveness, universality, portability and accessibility.

o The principles of the Canada Health Act embody many of the values that Albertans and Canadians expect from the health system. While the Canada Health Act focuses on what are termed "medically necessary" services – primarily hospitals and physician fees – Alberta’s publicly funded health system covers a much broader range of health services and the principles within the Canada Health Act have come to mean more than when originally drafted. (Here we go again, they are talking of the Canada Health Act as it is now and their intention is to change it to fit their privatize programs)

2. Committed to quality, including acceptability, accessibility, appropriateness, effectiveness, efficiency and safety.

3. The Health Quality Council of Alberta has developed a quality matrix outlining the dimension of quality in health. They include the six dimensions of quality included in the proposed quality principle. Sustainability is embedded in these dimensions; a quality system is a sustainable system. (This is what we have now with no changes)

4. Focused on wellness and public health.

o It can be said that what we have now is a disease system and that our approach needs to be fundamentally rethought so that public policy and priority is given to initiatives that will support healthy and resilient people, families and communities. (This is what we have now!)

5. Patient-centered across a full and integrated continuum of health services, from health to end of life. (If you don't have the cash earlier than you might think!)

o Focusing on what works for people and their care journey improves access and outcomes. A full continuum of care looks at health needs throughout a person’s life, including prenatal through to continuing care and palliative care (We have this now under the public system; when it goes private you have only what you can put up the cash for!)

6. Protective of infirm and vulnerable Albertans.
o A critical measure of the health system is how it cares for the most ill and vulnerable. (This crew is a breath away from compulsory euthanasia!)

7. Accessible to all Albertans regardless of ability to pay.

8. Albertans believe that need, not ability to pay, is a fundamental part of the social network in Canada. (This is what we have now, they are going to change it!)

9. Decision-making based on the best evidence available that enables the right care, in the right place, at the right time and by the right provider.

o Use of up-to-date evidence to determine what health services are delivered, how they are delivered, and where and by whom, will help lead to better health outcomes for Albertans and better use of the time and skills of providers and other health resources. (Nancy Bethowsky format; chewing gum for the mind!)

A discussion about themes for renewed health legislation
In its discussions around what key transformations should be enabled by new legislation, the Minister's Advisory Committee on Health discussed the importance of a system focused on wellness, one that helps build resilience in Albertans, families and communities, and one that puts patients and their families at the centre of their care.

The following themes outline broad policy areas that could support a patient-centred health system for the future. Do these themes reflect the changes that you think should happen? Would you change any of them? We want to know what themes you would propose – and why.

Optimizing the competencies and capacity of all health service providers (As in changing the Canada Health Act)
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