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 Tuesdayto spark discussion on funding, staffing and accountability among health care professionals, politicians, and the public. Theassociation, known as the CMA, is seeking adviceon how toachievetimely 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 andthe 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 reportersinanOttawa 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 reportaims to broaden the vision forhealth careto 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 morefunding for more serious cases, rather than payingthem a lump sum to cover all cases.

Incentive options

The report also suggests pay-for-performance incentives fordoctors and nurses who findways 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 facilitiesaddresses changes in hospitals over the last 30 years. Since patientsnow are often sent home the same day of their surgery rather thankept 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'sreport represents a change indirection away from privatization and a two-tiered system, whichthe associationhas focused on in the past,said Raisa Deber, a health-care analyst at the University of Toronto.

The groupseems to be reflecting more of a patient-centred approach that echoes the points made byretired senator Michael Kirby and former Saskatchewan premier Roy Romanowin their reports almost a decade ago.

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

To help health-care professionals do their jobs, the CMA wants information technology workto 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 ofsoftware 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 beheld this yearAug. 22-25 in Niagara Falls, Ont.

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