Dr. Philippe Couillard – Former Minister of Health(2003-2008) and Premier of Québec (2014-2018)
Julie Drury – Chair, Patient and Family Advisory Council, Ontario Ministry of Health and Long Term Care
Dr. Danielle Martin – Executive Vice President and Chief Medical Executive, Women’s College Hospital
Speaker: David Coletto – CEO and Founding Partner, Abacus Data
Moderator: André Picard – Health Reporter and Columnist, The Globe and Mail
Aramark Healthcare sponsored the fifth annual Great Canadian Healthcare Debate. The debate opened with an update from the winner of the 2018 Great Healthcare Debate, Mr. Nicholas Watters, Director, Access to Quality Mental Health Services at the Mental Health Commission of Canada. Since last year’s conference, the following results have been achieved:
· The Mental Health Commission of Canada developed a new department dedicated to improving access to quality mental health services
· Four additional communities joined the Roots of Hope Suicide Community Prevention initiative
· Facilitated over 60 conversations to inform the development of a post-secondary standard for mental health on Canadian campuses
· The Canadian government has committed to a $5M investment in mental health over the next ten years
With a federal election upcoming this fall, the debate focused on a public opinion poll on Canadians’ most pressing healthcare concerns; patients, patient care providers, health leaders and the general public had an opportunity to share issues that are most important to them. Mr. David Coletto, CEO and Founding Partner of Abacus Data, presented 15 different issues related to Canadian healthcare.
Prior to listening to the participants in the debate, the top three issues in healthcare in Canada, with percentages, were presented:
· 43% of poll respondents chose embracing digital technology as the most important issue
· 36% of poll respondents indicated that addressing poverty by providing a guaranteed basic income was the most important issue
· 20% of poll respondents selected closing the pharmaceutical coverage gap as the most important issue
Dr. Danielle Martin is the Executive Vice President and Chief Medical Executive, Women’s College Hospital, a practicing family physician, a professor at the University of Toronto and a national bestselling author. In 2019, she was the youngest physician to receive the F.N.G. Starr Award, the highest honour available to a Canadian Medial Association member. Her goal was to persuade the audience that reducing poverty is the best way to improve overall health in Canada.
Dr. Martin challenged the audience to think about what actually constitutes health. In her opinion, the most important policy Canadians can endorse to improve overall health is to support the elimination of poverty through a basic income guarantee for three main reasons:
1. Income is the most important determinant of health. The lower an individual’s income is, the more likely they are to get sick, suffer with a chronic disease and have a lower life expectancy. The social and economic environment determines 50% of the health of a population. Income disparity is associated with the premature death of 40,000 people per year (more than breast cancer, lung cancer and dementia). 20% of our spending in this country can be attributed to low incomes. A basic income guarantee is a viable solution to combat this issue. It is important to remember that 70% of people who lived in poverty were employed.
2. Poverty reduction is an unquestionable role for the government to play. There are very few healthcare policy issues that the federal government can actively get involved in and participate in to have a direct impact. It is very important that we offer an idea that the government can actually deliver improved healthcare.
3. We have a solid tradition of success in Canada to build upon. There are basic guaranteed income supplements in Canada already for seniors (old age security and the guaranteed income supplement) and for children and families (the Canada Child Benefit). In the 1970s in Manitoba, a guaranteed annual income was implemented, and hospitalization rates dropped by 8.5%.
Ms. Julie Drury, Chair, Patient and Family Advisory Council, Ontario Ministry of Health and Long Term Care, is passionate about the patient/family/professional partnership. She has firsthand experience in system navigation, complex care, care coordination, palliative care and patient safety. She is advocating for improved digital health to advance healthcare in Canada.
Communication and information are the foundation of an effective healthcare system. 90% of patient-related complaints are related to poor communication and process breakdowns. Data for Ms. Drury’s own daughter was difficult to access; in response to this issue, she made a binder of information with her daughter’s diagnosis, medical history, medications and the names of the specialists and clinicians who treated her because the hospital did not have accurate information despite having an electronic medical record system. Disjoined data affects patient safety, and it is an imbalance of power. Close to half of Canadians believe that digital improvements would improve overall patient care overall by reducing wait times and promoting the self-management of patient care.
Ms. Drury asked, “Does Canada need a federal digital health strategy?” Yes, she believes we do, and it needs to include standardization and structure to succeed. Innovation needs guidance and must adapt to patients, healthcare providers, etc. Innovation and design can focus on effective digital healthcare infrastructure to share information across and between healthcare organizations. Patients should own their health care information; hospitals and doctors should be custodians of that information. Currently, we do not have transparency when receiving care across the country; patients should be able to make decisions pertaining to their own care. The unintended consequences of multiple disjointed systems thinking that they will be connected later causes patients and families to suffer in the interim. The federal government can support and challenge provinces to think differently about information in the healthcare structure. Physicians, healthcare providers, patients and families deserve the level of efficiency and effectiveness that coordinated digital patient information can provide.
Dr. Philippe Couillard was a leader in the field of neurosurgery serving in hospital and academic settings in Canada and Saudi Arabia prior to entering politics in 2003. He was appointed Minister of Health and Social Services from 2003-2008. In 2013, he was elected to lead the Liberal Party of Québec, and was the Premier of Québec from 2014-2018. Dr. Couillard believes that the fundamentals of the healthcare system are good; we do not need to destroy the healthcare system to reform it. Globally, Canada has one of the highest investments in healthcare, but Canadians are also paying more than countries with user fees to access healthcare. The need for additional investment is due to a large gap in coverage of pharmaceuticals; 10% of Canadians are not covered, 10% are covered inadequately and 10% do not purchase medication due to the cost.
In Canada, the public sector funds 36% of total pharmaceutical spending while the UK covers 67% and Australia covers 48%. Dr. Couillard proposes introducing mandated insurance across Canada as Québec has already done. The public health expense needs limits, but the current mix of public and private insurance needs to be improved. He proposed the following recommendations:
· Completing the proposed reforms of the federal system’s listings and pricing
· Improving negotiation power by uniting public and private pharmaceutical buyers
· Providing more consistency on pharmacist’s fees and agreeing on a basic formulary
Universal pharma-care should be achieved by revising the current public and private mix of coverage. He encouraged the audience to follow the Canadian way by coming together in the spirit of respect, negotiation and compromise when needed. Dr. Couillard wants to close the gap to provide Canadians with universal, fair and affordable healthcare.
The moderator, asked the panelists to answer the following questions.
Dr. Martin was asked if providing a basic income for all Canadians would be too expensive. While she acknowledged this is a significant investment, it will save money and result in improved overall health for Canadians.
Ms. Drury was asked if patients should care about digital health information. She responded that lacking access and basic interoperability is frustrating, and can result in delays and safety issues. She also advocates that patients should own their data.
Has universal pharma-care in Québec been successful? Dr. Couillard stated that it can definitely be improved. Trying to decide what is “in” and “out” of the basket of services needs to be decided by the government.
The audience asked panelists the following questions:
· How can federal healthcare priorities be provincial healthcare priorities?
· How does your position improve the quality of life?
· If you give someone a basic income, will they spend the additional funds on items that are detrimental to their health?
· How do you ensure the private sector does not get involved in pharma-care resulting in larger bills?
· How do you think your arguments specifically improve the health of women and girls?
· Regarding the hemophilia model, do you think that greater involvement of patient groups like this be reproduced for other diseases?
· How can we engage federal politicians in each of your topics?
Dr. Couillard stated that healthcare is one of the most precious assets in Canada. It has been largely successful, but we have areas of half achievements (opportunities for improvement). From his political experience, he has learned to let other cabinet ministers have access to funding because there are other factors that impact healthcare, such as education, the environment and poverty reduction.
Ms. Drury encouraged the audience put information into the hands of patients to ensure safe coordination and allow physicians to do their best work with the information they have available. Everyone in this room is a healthcare leader who can challenge the digital health space. In each province, she advocated the audience to question why we are each operating on different digital platforms. Be bold and question this in your community. 76% of Canadians want a standardized digital health care platform.
Dr. Martin acknowledged that the other two debaters have important agendas worthy of improving healthcare across the country. Today, we must choose one argument or agenda. She thinks that we should endorse the policy that will impact the most amount of people, is least likely to be bogged down and has the power to combat not only illness but generate health.
At the end of the debate, the audience voted for the most important issues in healthcare in Canada. The results indicated that:
· 67% of poll respondents voted in favour of addressing poverty by providing a guaranteed basic income as the most important issue
· 27% of poll respondents chose embracing digital technology as the most important issue
· 6% of poll respondents selected closing the pharmaceutical coverage gap as the most important issue