Help transform medicare, CMA tells Canadians

Medicare needs to be transformed to meet the future needs of Canadians affordably, a physicians' group says in calling for new incentives and for feedback from Canadians.

The Canadian Medical Association released its report, Health Care Transformation in Canada: Change that Works, Care that Lasts, on Tuesday to spark discussion on funding, staffing and accountability among health care professionals, politicians, and the public. The association, known as the CMA, is seeking advice on how to achieve timely access to high-quality care for patients.

The point of the report is to "to encourage Canadians to let go of some of the complacency and the attitudes that they've had that, you know, 'We've got the best system in the world, so therefore we have to accept its shortcomings,'" CMA President Dr. Anne Doig told reporters in an Ottawa news conference.

Canada has good doctors, nurses and lab technologists in its system, she said. "But we can do much better, and we need Canadians to tell us what is it that you don't like. What would you like to see done better?"

The report aims to broaden the vision for health care to improving the health of the population, improving patient experiences and improving value for money spent on health care.

In the document, the group recommends:

• Building a culture of patient-centred care.
• Changing incentives to enhance timely access to quality care.
• Offering universal access to prescription drugs and continuing care outside of acute care facilities.
• Ensuring Canada has an adequate supply of health-care workers and information technology such as electronic health records.
• Building accountability and responsibility.

The proposed changes include activity-based funding — funding for hospitals that is based on the number of patients they see and treat and the complexity of the cases. The change would mean giving hospitals more funding for more serious cases, rather than paying them a lump sum to cover all cases.

Incentive options

The report also suggests pay-for-performance incentives for doctors and nurses who find ways to treat more patients and bring down wait times in high-priority areas, such as breast cancer treatment, while keeping quality of care high. The incentives would go not to individuals, but to the organizations they work for.

Offering continuing care outside of acute-care facilities addresses changes in hospitals over the last 30 years. Since patients now are often sent home the same day of their surgery rather than kept in hospital for several days, both their caregivers at home, like parents and spouses, and caregivers in the community need more support to offer post-operative care, Doig said.

The CMA's report represents a change in direction away from privatization and a two-tiered system, which the association has focused on in the past, said Raisa Deber, a health-care analyst at the University of Toronto.

The group seems to be reflecting more of a patient-centred approach that echoes the points made by retired senator Michael Kirby and former Saskatchewan premier Roy Romanow in their reports almost a decade ago.

Speaking of the CMA group, Deber said, "These are doctors who want to make sure that they're giving good care to their patients and don't like the idea that because people can't afford things, they're getting sub-optimal results."

To help health-care professionals do their jobs, the CMA wants information technology work to shift from building the information superhighway to using technology like electronic health records at the point of care. Doctors often weren't asked about their needs before that kind of software was designed, but they know what they are looking for, Doig said, and should have a hand in improving it. 

The group included timelines for its recommendations. For instance, it wants construction to begin immediately on more long-term care facilities.

The report was released ahead of the group's annual general meeting, which will be held this year Aug. 22-25 in Niagara Falls, Ont. 

The document also sets out timelines for pharmacare, long-term care and accountability in time for the negotiation of the next federal, provincial and territorial health accord in March 2014.