Seniors needing the most help are not getting the care they need, says report

The Health Council of Canada releases a new report on home care in Canada

TORONTO, Ontario April 16, 2012 – Today, the Health Council of Canada released Seniors in need, caregivers in distress: What are the home care priorities for seniors in Canada? Download report here (.pdf).

The report provides the first cross Canada snapshot on the needs of home care clients and their caregivers. The report looked at data from five regions including Nova Scotia, Ontario, Manitoba, British Columbia and Yukon and found that seniors who need home care the most are not getting the level of care they need. One-third of seniors in the Health Council’s sample have complex health needs, often involving both a physical disability and cognitive impairment such as dementia, but these people receive only a few more hours of home care services per week than what is offered to seniors with moderate care needs.

This leaves the burden on the shoulders of many family caregivers in Canada. Caring for a high-needs senior with limited outside support may stretch family caregivers beyond their capacity. Approximately 40-50% of seniors with the most complex health needs have distressed caregivers, who report they are finding it difficult to continue to provide care, and that they have feelings of stress, anger, and depression.

A burned out caregiver cannot help anyone if they end up in the hospital or become otherwise unable to function. In fact many caregivers are seniors themselves, at risk of health crises under stress. The report calls for a system that regularly assesses the situations of seniors and their family caregivers and provides support, whether it is additional hours of home care or faster placement a loved one into a long-term facility.

“Home care has become an integral part of the health care system, not something that happens off-side in the community,” said Lyn McLeod, Councillor with the Health Council of Canada. “Governments need to make home care a priority by developing and implementing an integrated continuing care strategy. Jurisdictions can adapt what is working by learning from innovative practices.”

The most successful programs and policies bring together, home care, primary care and acute care under one coordinating body. To do this, the report suggests a change in the way funding is allocated. Canada currently spends considerably more on long-term care facilities than home care. Among countries monitored by the Organisation for Economic Co-operation and Development (OECD), Canada has one of the larger gaps between spending on long-term care and home care, 0.96 % of GDP for long-term care and 0.21% of GDP for home care.

The report also calls for integration of home care across sectors and services as well as the provision of support for family caregivers. As hospitals are the main source of referrals to home care, when seniors leave the hospital, they should experience a smooth transition from hospital to home care. And once a senior is receiving home care, the family physician should be included as part of the home care team.

“When home care is properly valued and integrated into the health care system, it can improve the health and well-being of many seniors and their families, and reduce costs to the health care system,” said John G. Abbott, CEO of the Health Council of Canada.

The report also addresses the issue of the Alternate Level of Care (ALC) patients – people who don’t need the acute care of a hospital, but still need some care. Often they are awaiting placement in a long-term care institution or rehabilitation facility. ALC patients use an average of 5,200 hospital beds every day, at high cost to the health care system. Many of these people are seniors who could be cared for at home if appropriate supports were in place.

About the Health Council of Canada

Created by the 2003 First Ministers’ Accord on Health Care Renewal, the Health Council of Canada is an independent national agency that reports on the progress of health care renewal. The Council provides a system-wide perspective on health care reform in Canada, and disseminates information on leading practices and innovation across the country. The Councillors are appointed by the participating provincial and territorial governments and the Government of Canada.

Put patients first, says Health Council

The Health Council of Canada shares insights on patient engagement from patients and Canada's leaders in health care

VANCOUVER, February 23, 2012 /Canada NewsWire/ - Today, the Health Council of Canada released Turning what we know into action: A commentary on the National Symposium on Patient Engagement, calling for the inclusion of the patient voice when designing, planning and delivering health care services in Canada. The goal of the symposium is to raise awareness of the potential of patient engagement as a means of improving the health care system.

"Patients with informed voices have a role to play in health system planning and ultimately on health care delivery," says John G. Abbott, CEO of the Health Council of Canada. "However, patients must feel empowered and must be properly oriented to effectively assume that role."

In October 2011, the Health Council of Canada held a national symposium on patient engagement. Patients, representatives from patient organizations, provincial and federal government representatives, researchers, health system administrators and health care providers shared their perspectives on patient-centred care.

A strong message from participants coming out of the symposium is the need to have patient engagement as a performance goal.

"We know governments make the most progress on their goals when specific objectives and concrete targets are set up front," says Mr. Abbott.

The patient experience should be measured at all levels of the health care system. The measurements should be used to set targets for higher quality care that is in keeping with patient experiences and expectations.

An equally strong message echoed by participants is the need to shift from a provider-focused to patient-centred care. To allow patients to take a more active role in their health care, governments and health care providers must shift the way health care is delivered to focus on patient-centred care. Patient-centred care concentrates on relationships that are a two-way exchange of information: patients are empowered, providers are willing to listen to them, and decisions are made as a team.

"Businesses listen to their customers, in the business of health care, the customers are the patients, and must be heard," says Mr. Abbott.

A recent report released by the Health Council of Canada, How Engaged are Canadians in their Primary Care: Results from the 2010 Commonwealth Fund International Health Policy Survey, revealed that only 48% of Canadians feel involved in and are actively participating in their own health care. This means less than half of Canadians are taking a more active role in maintaining their health, oftentimes leading to increased satisfaction with their care. Engaged patients better understand and know more about their care, which leads to better use of health care services and resources. The symposium reinforced these findings.

About the Health Council of Canada

Created by the 2003 First Ministers' Accord on Health Care Renewal, the Health Council of Canada is an independent national agency that reports on the progress of health care renewal. The Council provides a system-wide perspective on health care reform in Canada, and disseminates information on leading practices and innovation across the country. The Councillors are appointed by the participating provincial and territorial governments and the Government of Canada.

Video: What we heard from over 160 participants at our National Symposium on Patient Engagement

Health Council of Canada releases 2010 Commonwealth Fund International Health Policy Survey results

Canadians visiting emergency departments for care, instead of seeing primary health care providers

TORONTO, Novovember 19, 2010 /Canada NewsWire/ - Today, the Health Council of Canada released survey results from the 2010 Commonwealth Fund International Health Policy Survey. The bulletin called, How Do Canadians Rate the Health Care System? examines Canadians' insights into the performance of the health care system.

The survey results indicate that although, Canadians' overall view of the health care system has improved over time, they recognize the need for key improvements to the system. Over half of Canadians surveyed feel that fundamental changes are required to make the system work better.

"Canadians are saying that they want to keep Medicare. They believe the quality of medical care is excellent, but are not happy with their ability to access care in a timely and coordinated way. There are gaps that can be fixed in order to improve our current system," said John G. Abbott, CEO, Health Council of Canada. "This message is consistent with the Romanow Commission Report that was released in 2002."

The survey shows that of all the countries surveyed, Canada fares worst when it comes to access to care after hours - anywhere other than the emergency room. In fact, 37% of Canadians say it is very difficult to get care in the evenings, weekends, or holidays without going to the emergency department. Furthermore, in the last two years, almost half (47%) of Canadians who went to an emergency department yet have a regular doctor said they could have been treated by their regular care provider had he or she been available.

"This means that Canadians may be inappropriately using emergency departments because they do not have adequate access to their primary care giver," says Abbott. "…which is overburdening hospitals and has an overall negative impact to health care system in Canada."

Other areas where Canada did not fare well, compared to international counterparts were around timeliness and coordination of care. In terms of timeliness, only 45% of Canadians (well under the international average of 65%) said they were able to get an appointment on the same or next day when sick or in need of medical attention. Canada ranked the worst out of the 11 countries surveyed in this area.

Furthermore, some Canadians feel that their time had been wasted because their care was poorly organized or coordinated. For example, 12% of Canadians said their test results or medical records were not available at their medical appointment.

The survey also points out that in spite of our universal Medicare system some Canadians feel that costs are a barrier to care, particularly when it comes to prescription drugs. One in 10 respondents said they had not filled a prescription or taken medication due to cost.

The survey highlights gaps in our health care system that Canadians feel need to be resolved. Canadians need timely access to both primary care providers and specialists, to avoid overuse of emergency departments. The National Pharmaceuticals Strategy needs to be implemented to ensure that no Canadians are compelled to skip or adjust medication dose due to cost. And there must be wider adoption of electronic medical and health records to improve information sharing between physicians and specialists to ensure accurate and up-to-date test results and medical records are available. The Health Council of Canada believes that Canadians have spoken clearly, with an expectation that their concerns identified in the survey will be addressed.

About the Survey

The 2010 Commonwealth Fund International Health Policy Survey reflects the perceptions of a random sample of about 20,000 adults across 11 countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States. Participants were interviewed by telephone between March and June, 2010. This included 3,309 Canadians. The core study was funded by the Commonwealth Fund. The Health Council of Canada sponsored a portion of this study along with the Ontario Health Quality Council and the Quebec Health and Welfare Commissioner (Commissaire à la santé et au bien-être du Québec). www.cmwf.org.




About the Health Council of Canada

Created by the 2003 First Ministers' Accord on Health Care Renewal, the Health Council of Canada is an independent national agency that reports on the progress of health care renewal in Canada. The Council provides a system-wide perspective on health care reform in Canada, and disseminates information on best practices and innovation across the country. The Councillors are appointed by the participating provincial and territorial governments and the Government of Canada.

To download reports and other Health Council materials, visit www.healthcouncilcanada.ca.

New report shows overuse of diagnostic imaging and inappropriate prescribing

Health Council of Canada releases report on how physicians' decisions affect health care services in Canada

TORONTO, September 27, 2010 /Canada NewsWire/ - A report released today by the Health Council of Canada, Decisions, Decisions: Family Doctors as Gatekeepers to Prescription Drugs and Diagnostic Imaging in Canada, calls for better management of prescription drugs and diagnostic imaging services in this country. The report examines the increasingly complex role of family physicians and the effects of their decisions on usage of Canada's health care services.

As the first point of contact with the health care system for many Canadians, family physicians make decisions that affect patients' treatments, and also impact the health system as a whole. The report finds that physicians, today, are faced with many challenges, that they are prescribing more medications and ordering more diagnostic imaging tests than ever before, and that they need support to avoid inappropriate and over-use of these costly services.

"Family physicians act as 'gatekeepers' and play a key role in ensuring that our health care services such as drugs, diagnostics, and specialist services are being used appropriately," says John G. Abbott, CEO, Health Council of Canada. "Given the host of factors that influence their decision-making, we can do more to assist family physicians in curbing the overuse of diagnostics and drugs, and make significant improvements in managing our health care system."

Over the past 10 years, the number of prescriptions filled at community pharmacies has almost doubled - from 272 million in 1999 to 483 million in 2009. This suggests that some Canadians are getting drugs they do not need, while others are not getting medications from which they could benefit - putting into question the appropriate use of prescription drugs in Canada. Furthermore, the report indicates that between 1990 and 2009, the number of CT scanners more than doubled from 198 to 465 and within that same period MRI scanners increased from 19 to 266 - resulting from federal investments over the past decade. Compared to 2003, there has been a 58% increase in CT scans and 100% increase in the number of MRIs conducted.

The report acknowledges the difficulty in tracking how physicians' decisions affect the use of health care services. For example, available data do not show conclusively whether the use of family physician services has increased or decreased over the past decade, despite an increase in the number of family physicians in practice.

The report further finds that use and adherence to clinical practice guidelines is too low. Clinical practice guidelines inform providers - family physicians - about appropriate care while helping to reduce the variation in care.

Similarly, improvements are needed in terms of use and access to electronic medical and health records across the country. Canada continues to lag behind many other countries in the use of health information technology. Few family physicians use electronic medical records. The use of computers is often confined to administrative duties such as electronic billing and scheduling appointments, but not clinical work. The increased adoption of better usage of electronic health systems will lead to more comprehensive data on how drugs are prescribed and used, linking them back to effects on health outcomes, while encouraging adherence to clinical practical guidelines.

"We can make up for this lack of information through additional research and the wider adoption of electronic health records by family physicians," stated Abbott. "It is a critical foundation for safe and appropriate prescribing and medication management. It is essential that an electronic system is in place to efficiently assist physicians in following clinical practice guidelines, making the best decisions for their patients and for the sustainability of our health-care system."

About the Health Council of Canada

Created by the 2003 First Ministers' Accord on Health Care Renewal, the Health Council of Canada is an independent national agency that reports on the progress of health care renewal in Canada. The Council provides a system-wide perspective on health care reform in Canada, and disseminates information on best practices and innovation across the country. The Councillors are appointed by the participating provincial and territorial governments and the Government of Canada.

To download reports and other Health Council materials, visit www.healthcouncilcanada.ca.

Join the discussion visit www.canadavalueshealth.ca

Nova Scotia plan to lower prescription pricing a step in the right direction: Health Council of Canada

TORONTO, September 24, 2010 /Canada NewsWire/ - The Health Council of Canada applauds the Nova Scotia Department of Health for their steps towards ensuring low drug prices in their province. The plan includes meeting with groups, such as community pharmacies, doctors, medical staff at health authorities, senior groups and drug manufacturers for input on how to lower prices for prescription drugs and contain drug costs.

In a recent report, Generic Drug Pricing and Access in Canada: What are the Implications?, the Health Council of Canada stated that the goal of any drug-policy reform should be to create an environment that addresses the needs of patients at an affordable cost that can be sustained over the long term.

"This initiative is a step in the right direction to ensure that the people of Nova Scotia can afford the prescription drugs they need. It will also help to ensure that drugs programs are affordable and sustainable into the future," said John G. Abbott, CEO of the Health Council of Canada.

Nova Scotia's plan outlines five measures that are being considered to lower prescription drugs prices: Set generic drug prices, limit pharmacy rebates, tender for one or more drugs, establish rules around price increase, and define the price paid to pharmacies for drugs.

These measures are in line with the strategy recommended by the Health Council of Canada in their generics report, which included six critical success factors:

Effective pricing strategies;

...Appropriate and efficient use of generics;
...Alternative drug-distribution channels;
...Diverse offering of pharmacy services;
...High consumer involvement; and
...Optimal government involvement.

"Prescription drugs must be affordable and accessible to all Canadians," said Abbott. "It is possible, if governments take the steps we outlined in our report."

About the Health Council of Canada

Created by the 2003 First Ministers' Accord on Health Care Renewal, the Health Council of Canada is an independent national agency that reports on the progress of health care renewal in Canada. The Council provides a system-wide perspective on health care reform in Canada, and disseminates information on best practices and innovation across the country. The Councillors are appointed by the participating provincial and territorial governments and the Government of Canada.

To download reports and other Health Council materials, visit www.healthcouncilcanada.ca.

Generic Drug Prices and Access: A Discussion Paper from the Health Council of Canada

TORONTO, June 18, 2010 /Canada NewsWire/ - More public and private dollars are being spent to purchase pharmaceuticals for Canadians each and every year. At a time when flattening the healthcare cost curve is at the top of many government agendas, the Health Council of Canada is pleased to see the recent attention paid to controlling drug costs and particularly the costs of generic drugs. Today, encouraged by recent calls for greater coordination of drug policies, The Health Council of Canada released a commissioned discussion paper written by SECOR Consulting, Generic Drug Pricing and Access in Canada: What are the Implications? This independent paper is designed to move the discussion of possible reforms forward on an important part of the drug file - the pricing and distribution of generic drugs - and bring transparency to this important area of public health policy.

A year ago, the Health Council of Canada published a report on the progress of a National Pharmaceutical Strategy (NPS.) At the time, we asked governments to rededicate themselves to this important element of health policy nationwide. Drug pricing was a challenge identified in the 2003 First Ministers' Accord on Health Care Renewal. In the follow-up 2004 10-year Plan to Strengthen Health Care, First Ministers said that they wanted to "accelerate access to non-patented (generic) drugs and achieve international parity on prices." The Health Council of Canada is encouraged by some recent provincial initiatives to tackle generic prices, which some estimate could save taxpayers, consumers and businesses as much as $800 million a year.

"Canadians pay some of the highest prices in the world for generic drugs," said John G. Abbott, CEO, Health Council of Canada. "The paper we are releasing today should help policy makers and people across the country move forward to curtail the cost of generic drugs for both public and private plans while maintaining access and quality of service."

Governments, through their own health plans, have traditionally set the price for generic drugs - the safe, effective and cheaper "copies" of brand name drugs that come to market after the patent exclusivity of the brand name drug has expired. This discussion paper explains how government pricing policies consciously and otherwise have produced a system that does not get the best price for the taxpayer or for private sector employers. The current way governments and others set generic prices leaves "too much money" with manufacturers, distributors and retailers that otherwise could create savings for the taxpayer or be used in other areas of healthcare.

"Our goal in publishing this discussion paper is to shed light on generic drug pricing issues in order to help Canadians understand what is at stake and to encourage broad public discussion," said Dr. Jeanne Besner, Chair, Health Council of Canada. "Knowing we have options for real reform should be helpful to governments in the current fiscal environment."

"This discussion paper highlights the complex reasons as to why generic drug prices are so high and the longstanding lack of transparency about how prices are set. It suggests options available to governments in order to institute reforms, reduce costs, and increase the transparency of generic drug transactions," stated Abbott.

The paper offers six basic suggestions:

- Drug insurance plans could revisit their maximum reimbursement prices since a body of evidence suggests that Canadian prices are too high;

- Reimbursement prices could be set at the pharmacy level;

- The use of alternative and competing distribution channels could be encouraged;

- Using the pharmacist to provide additional paid services would moderate the impact of reducing generic-drug prices and benefit the healthcare system;

- Drug plans, including employer-sponsored plans, could use tiered formularies to encourage their beneficiaries to use low-cost drugs;

- Provincial and territorial drug plans could ensure that newly approved drugs are listed on their formularies in a timely manner.

Discussion Paper website

Since generic drug prescriptions represent more than half of all prescriptions written in our health systems, it is important that Canadians have better information about generic drug pricing. The Health Council of Canada encourages Canadians to join in a broader public discussion on this critical health care issue and become better informed.

The Health Council of Canada, created by the 2003 First Ministers' Accord on Health Care Renewal is mandated to monitor and report on the progress of health care renewal in Canada. Councillors were appointed by the participating provinces, territories and the Government of Canada. To download the discussion paper or view past reports, visit www.healthcouncilcanada.ca