Setting the Context: The BC Health System

Andrew Wray – April 8, 2013

The Plan:

• The building blocks

• The challenges

• The strategy

• What this means for improvement leaders

Federal Government

• Delivery for specific populations

• Regulation of food, drugs and devices

• Some aspects of public health

• Funding partner for Provincial delivery

– Canada Health Act (1984)

Provincial Governments

• Administration of public insurance plan

• Regulation of professions

• Delivery of many health care services (an increasing role)

1990sOver 300 health

organizations

1990sOver 300 health

organizations

199652 Local Health

Authorities

199652 Local Health

Authorities

2001Five RegionalAuthorities

2001Five RegionalAuthorities

The BC Health Delivery – An Evolving System

Ministry of HealthGeneral Responsibilities

•Leadership and support for the health service delivery system•Health promotion and protection•Aboriginal health promotion•Public health planning•Provincial Health Officer•Performance management of the health authorities•Health human resource planning•Health regulation and licensing•Health information systems and e-health•Women and seniors•End of life and palliative care

• Community and home support services• Assisted living and residential care• Community care licensing• Mental health and addictions services• Communicable diseases prevention and addictions

services promotion• Healthy living/chronic disease prevention• Medical Services Plan• ActNow BC • HealthLinkBC• BC Bedline• PharmaCare• Vital Statistics• BC Ambulance Service• End of life and palliative care

Major Agencies, Boards and Commissions

Health AuthoritiesMedical Services CommissionBC Patient Safety & Quality Council

Patient Care Quality Review BoardsHospital Appeal BoardCommunity Care and Assisted Living Appeal Board

Follow the Money!General Revenue Fund ($41B)

Ministry of Health ($15.7B)

Health Authorities ($13.4B) MSC

Drugs ($1.1B)MSP ($3.8B)

Physician Payment

Medical Services Commission

• Includes representatives of the Ministry, BCMA and health authorities

• Responsible for delivering the public insurance plan (MSP)

• Responsible for delivering the Pharmacare Plan

Regional Health Authorities• Deliver health services in their geographic regions

• All organized differently

• Have a few commonalities:

– Many employees/few employed MD– Both delivery and funding agenda– Accountability– Run, or contract, hospitals, clinics, health units,

residential care homes, home services, etc.

Provincial Health Services Authority• Covers a variety of specialty services delivered provincially

– BCCA– Children’s– Women’s– Transplant– CDC– MHAS– BCAS– Etc.

• Shares many of the same features as the regional HAs

Private Providers

• Includes both insured and uninsured services

• Wide variety of settings/services

– Most physician practices– Pharmacies– Dentists offices– Chiro/physio/etc– Residential facilities– Some hospitals

Some Blurry Lines

• HSSBC services

• Lower Mainland Consolidation

Other players -• Regulatory Colleges – sets standards for professions.

• Associations and Unions – have huge influence on health care

• Federal government – major funding partner – has significant influence on delivery.

• Other insurance programs – WCB, extended health, etc.

• HSSBC – Purchasing organization – “economies of scale”

• HSPO – Additional mechanism for distributing finding – “patient focused funding”

• Universities/Colleges – training of future health professionals

• Physician negotiated committees

The Challenge

Manage the unprecedented costs of delivering medical care while improving the quality of care from prevention to end-of-life.

BC Health Spending Growing

Source: Public Accounts, Ministry of Health Services/Ministry of Healthy Living & Sport Estimates, August 2009

Source: Public Accounts, Ministry of Health Services/Ministry of Healthy Living & Sport Estimates, August 2009

BC Provincial Government Budget for Health 1993/94 to 2011/12

$6.5 $6.7 $6.9 $7.4 $8.0$8.7

$9.7 $10.2 $10.5 $10.6$11.4

$12.1$13.0

$13.6$14.9

$15.8

$7.1$6.2

$14.1

$0.03$0.06

48%

47%

34%34% 35% 35%37% 38% 39% 38% 39%

41% 42%43% 43% 43% 44% 45% 45%

$16.4

$14.7$15.6

$14.2

$13.2

$12.1$11.7

$10.8$10.4$10.4

$9.6

$8.5

5

10

15

20

93/94 94/95 95/96 96/97 97/98 98/99 99/00 00/01 01/02 02/03 03/04 04/05 05/06 06/07 07/08 08/09 09/10 10/11 11/12

Bill

ion$

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

% o

f CR

F

Ministry Actuals Ministry EstimatesMinistry of HL & S ($59 Million in 08/09 and $35 Million in 09/10) CRF Health Function as % of total CRFProvincial Government Health Expenditure estimates/health function

16

Total Provincial Health Spending:1990 – 32% of budget or $4.8 billion2001 – 38% of budget or $9.5 billion

2011 – 45% of budget or approximately $16 billion

20111990

Rising Cost of Health Care

$0

$10,000

$20,000

$30,000

$40,000

$50,000

$60,000

2005 2008 2011 2014 2017 2020 2023 2026 2029

Mill

ions

Utilization

Health-Specific Price Inflation

General Price Inflation

Aging

Population Growth

Baseline

Improved Management

Improved Management

Efficiency

Efficiency

Key drivers of cost growth

in 2008 in 2025

Population is aging: percent aged 75+

Source: BC Stats, People 33

Source: BC STATS, July 2008

Percentage of BC’s population over the age of 65 increases from about 12% to 25% from 2001 to 2036.

$1,340$2,672

$5,887

$10,405

$20,267

$0

$5,000

$10,000

$15,000

$20,000

< 45 45-64 65-74 75-84 85+

Sp

end

ing

per

Cap

ita

($)

Use of Services Increases as People get Older

5,079,0205,079,020 2,530,9602,530,960 661,588661,588 436,056436,056 176,476176,476

Population Segments will grow at different rates

21

The Strategy

• Prevention and demand management

• Delivery in appropriate setting

• High quality services

• Efficient management practices

Pric

e an

d/or

dem

and

Community Public Health

Individual Prevention

Long-term Condition

Management

Avoiding Hospital

Admissions

Hospital Care

Rehabilitation End-of- Life care

Service Plan• Effective health promotion, prevention and self-management to improve the

health and wellness of British Columbians. – Individuals are supported in their efforts to maintain and improve their health through

health promotion and disease prevention.

• British Columbians have the majority of their health needs met by high quality primary and community based health care and support services.

– Providing a system of community based health care and support services built around attachment to a family doctor and an extended health care team with links to local community services.

• British Columbians have access to high quality hospital services when needed.– Acute care services are accessible, effective and efficient.

• Improved innovation, productivity and efficiency in the delivery of health services.

– Optimize supply and mix of health human resources, information management, technology and infrastructure in service delivery.

– Drive efficiency and innovation to ensure sustainability of the publicly funded health system.

Innovation and change agenda slide

Prevention

• Review of core public health functions

• Healthy FamiliesBC

• ActNow BC

Integration of Primary and Community CareStarted with Physician Primary Care- Making family practice a more attractive option

- General Practice Services Committee – improving deliveryPractice Support ProgramFull Service Incentive ProgramDivisions of Family PracticeCHARD – community resource directoryAttachment

- Has also led to Specialist Services Committee and Shared Care Committee

• Building on the work in primary care

• Linking between primary, home care, residential care, community care, etc.

• Continued focus of chronic diseases, specific populations

• Seniors Action Plan

Integration of Primary and Community Care

High Quality Hospital services

• Clinical Care Management – Improving Clinical Care

– Implementation of best practice guidelines to improve the quality of care delivered.

Supporting Strategies

So what does this mean for making improvements?