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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, OntarioSource: Statistics Canada
20.6
6.5 6.5
45.2
8.77.4
5
18.2
6.9 6.6
11.2
7.1 6.4
43.7
0
5
10
15
20
25
30
35
40
45
50
0-14 15-19 20-24 25-54 55-64 65-74 75+
1996 2006
People - We Are Living Longer – Life Expectancy (Ontario)
Source: Statistics Canada
78.3
82.7
71.8
78.1
66
68
70
72
74
76
78
80
82
84
1979 2004
Men Women
People – More Chronic Disease, OntarioSource: Statistics Canada
1,810,890
843,339
300,315
692,839
1,321,367
510,523
0
200,000
400,000
600,000
800,000
1,000,000
1,200,000
1,400,000
1,600,000
1,800,000
2,000,000
Arthritis Asthma Diabetes
1996 2005
People – Five Year Survival Rate, Cancers, OntarioSource: Cancer Care Ontario
8579
56 53
16
98
87
6358
16
0
20
40
60
80
100
120
Prostate Breast Colorectal Other Lung
1990-1994 2000-2004
People – More Immigration, OntarioSource: Statistics Canada
73.7
0.7
70.8
28.3
0.9
25.6
0
10
20
30
40
50
60
70
80
Non immigrant Immigrant Other
1996 2006
People – Increasing Levels of Education, OntarioSource: Statistics Canada
20.6
24.4
11
19.3
24.72526.7
30
13.6
8.8
0
5
10
15
20
25
30
35
Did not finish highschool
High School Tradescertificate/diploma
College University
2001 2006
People – Changes in Places of Work, OntarioSource: Statistics Canada
0.6
8.2
84.1
0.6
9.7
82.6
7.1 7.1
0
10
20
30
40
50
60
70
80
90
Work at home Work outside Canada No fixed workplace address Usual place of work
2001 2006
Health Care – The Budget Dollar, OntarioSource: Ontario Government
33
17 16 16
10
3 3 2
42
12
21
10
4
13
0
5
10
15
20
25
30
35
40
45
1996 2007
Health Care – Components of Provincial Spending within Ontario Health Care (Public $)
Source: CIHI
35.6
21.1
3.2 2.9
5.44.4
1.6 1.5 2.1
42.4
47.1
9.3
8.58.6
23.224.7
7.2
4.3
9.9
6.1
9.4
10
5
10
15
20
25
30
35
40
45
50
1986 1996 2006
Hospitals
Other Inst
MDs
Drugs
Capital
Public Health
Admin
Health Care – Changes in Hospital Care, OntarioSource: CIHI
948,858
1,079,487
5,968,216
7,037,675
0
1,000,000
2,000,000
3,000,000
4,000,000
5,000,000
6,000,000
7,000,000
8,000,000
1996 2006
Hospital Discharges Length of Stay (days)
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
6.7
8.2
8.9
9.3
6.3
6
7.6
8
9
6
0 1 2 3 4 5 6 7 8 9 10
ON
NFL
QC
MB
SK
1996 2006
Health Care – Use of Telehealth, OntarioSource: MOHLTC
3,660
15,565
23,472
0
5,000
10,000
15,000
20,000
25,000
2003/04 2004/05 2005/06
Health Care - % of all personal expenditures on health care, Canada
Source: Statistics Canada
1999 4.8%
2003 5.2%
2007 5.5%
Health Care – Personal Expenses, $millions, Canada
12,656
1,265
15,906
13,025
1,653
20,996
17,951
2,234
9,175
0
5,000
10,000
15,000
20,000
25,000
medical drugs hospital
1999 2003 2007
Health Care – Ontarians in Family Health Teams, Source: MOHLTC
1,100,000
1,400,000
1,700,000
0
200,000
400,000
600,000
800,000
1,000,000
1,200,000
1,400,000
1,600,000
1,800,000
2005 2006 2007
Health Care - After Hours Care, OntarioSource: 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 PhysiciansSource: 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 2010Source – Canada Health Infoway
100 100
50
88
59
40
30
95
0
20
40
60
80
100
120
Diagnostic Imaging Drugs Labs Electronic healthrecord
Goal by 2010 Per cent Achieved by 2010
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
