Evidence of meeting #67 for Health in the 41st Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was patients.
A recording is available from Parliament.
President and Chief Executive Officer, Canadian College of Health Leaders
Well, it depends on the type of hospital. Academic health science centres are quite expensive. A normal community hospital would be in the range of maybe $1,200 a day. As for teaching hospitals, Dr. Tétreault would know. St. Boniface would be—
President and Chief Executive Officer, St. Boniface Hospital
It's more like $1,500. But acute cases are much more expensive than patients who stay for a long time.
Liberal
Hedy Fry Liberal Vancouver Centre, BC
But staying in the bed is also a huge cost in a hospital.
What are the costs for doing the community and home care in Sweden per capita? Do you have that information?
President and Chief Executive Officer, Canadian College of Health Leaders
I don't have that. The only thing I can tell you is that we look at two measures related to performance. We look at percentage of GDP investment. We're at around 11.5% or 11.6% right now. They're sitting at below 10%, and it had been around 9% for probably 10 to 15 years. At one time, we were around 9%, but we've grown quite quickly. We also look at the average cost per patient, and the total cost for citizens, to get an average. They're about $500 a person cheaper, and that's with a bigger basket of insured goods.
Liberal
Hedy Fry Liberal Vancouver Centre, BC
Thank you.
You talked about fragmentation of care across the country, and we see some great things happening in some provinces, but there is no ability to pull them in and look at those best practices nationally.
You know that the 2004 health accord looked at a jurisdictional flexibility that was agreed on between provinces and the federal government. One of the five objectives was shifting to home and community care, where possible, and using hospitals and physician care only where necessary. That was going to achieve some of the things.
It also looked at a health human resource pan-Canadian strategy. None of those things has come to pass. I think while you give us great recommendations for innovation, it seems as if we have not been able to take those on.
I just wanted to quickly mention, Dr. Fotti, that the “Patient's Home” is a remarkable new way of actually implementing some of what Mr. Racette was talking about. I want to congratulate you, as you have just done exactly what the college is suggesting in terms of the home, thereby looking at a multi-disciplinary team of care—community, home care, using a hospital only when absolutely necessary for acute care. I want to congratulate you on actually making that so, and I'm hoping the college will get that implemented across the country.
Finally, I want to talk quickly to Dr. Montaner and Tom Kerr.
I want to congratulate you, Dr. Montaner, on the Queen's Diamond Jubilee medal you received, and all of the medals and accolades you've received around the world for this remarkable Canadian achievement. I don't know but some people have actually probably overdone it and said that this is probably the closest we've come to Banting and Best in Canada in the past. It's a Canadian innovation, and I know the World Health Organization has looked at the whole treatment as prevention, the heart program in B.C.
Can you tell me what it costs for the whole program in B.C., both the “seek” and then the “treat” that is now free in B.C.? What's the total cost of that?
Director, British Columbia Centre for Excellence in HIV/AIDS
The cost per year, if you consider drugs and...[Technical difficulty—Editor]
Conservative
Director, British Columbia Centre for Excellence in HIV/AIDS
Thank you, Ms. Fry, for your questions and your comments.
The cost of the program in British Columbia at the present time is in the order of $120 million per year, considering that we have 14,000 people infected with HIV in the province and we have approximately 7,000 people actively engaged on antiretroviral therapy. The average cost per patient is in the order of $15,000 per patient for all treatment, and of course it's half of that if you consider the whole bulk of people infected with HIV.
As I said, the return on the investment is actually phenomenal. This has been acknowledged by the World Health Organization, and for that reason, UNAIDS and WHO, among others, have recommended that this approach be actually implemented throughout the world. Steps are being taken for this to happen.
Liberal
Hedy Fry Liberal Vancouver Centre, BC
I'm sorry, what is the cost per year in the provincial budget, and hospital costs, etc., prior to seek and treat? What was the cost for taking care of HIV cases in hospital, in emergencies, etc.? What is your total cost that you can give us, Julio, Dr. Montaner?
Director, British Columbia Centre for Excellence in HIV/AIDS
I cannot give you a figure, but it will be manyfold greater than we are currently spending. In other words, the return on the investment is in the order of three to five to one, because really what we're doing is not only stopping people from becoming sick, but we're putting them back on their feet so that they can continue to contribute to society.
As I said, we have had zero vertical transmission over the last seven years in the province of British Columbia. The childhood epidemic has been eliminated. But in addition to that, by decreasing by 65% the number of new infections, what we're doing is we are eliminating the emergence of new cases, which has an exponential growth as a result of continued transmission.
Liberal
Hedy Fry Liberal Vancouver Centre, BC
Thank you, Dr. Montaner.
I wanted to suggest that this could be a part of a national pharmacare strategy, which again was one of the objectives of the 2004 health accord that has never come to pass.
I want to ask Dr. Kerr something. The words “harm reduction” have a huge loaded moral connotation for a lot of people, and yet we heard Dr. Tétreault talking about harm reduction in the hospital—washing your hands so that you don't spread infection.
Can you explain harm reduction in a way that takes away that moral, value-laden judgment?
Director, Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS
Sure. Harm reduction really isn't restricted to drug use. It's surprising that it has carried stigma when it's applied in that area. It's in many other things, including light beer and low-nicotine cigarettes. “Don't drink and drive” campaigns are a form of harm reduction. Really, it seems that it's in Canada that we're struggling with these words; it's not a problem for the United Nations, and it's not a problem for the World Health Organization or the Canadian Medical Association. It's really about evidence-based practice of what works and what doesn't.
Conservative
Conservative
Colin Carrie Conservative Oshawa, ON
Thank you very much, Madam Chair. I want to thank all of the witnesses here today for excellent presentations.
I want to start off my questioning, but I'm going to be sharing it with Mr. Lizon.
Mr. Racette, what is the cost in Canada for a hospital bed per day? Do you have any idea?
President and Chief Executive Officer, Canadian College of Health Leaders
I don't have it here, but we could probably get it from CIHI, the Canadian Institute of Health Information, and let you know what it is.
Conservative
Colin Carrie Conservative Oshawa, ON
Okay.
Is there anything stopping provinces from adopting these difference practices? We heard about a practice in British Columbia. If another province, such as Saskatchewan, wanted to adopt these practices, is anything stopping them from doing so?
President and Chief Executive Officer, Canadian College of Health Leaders
No, there isn't anything stopping them.
Conservative
Colin Carrie Conservative Oshawa, ON
I was just curious.
I liked the talk about different models. You were talking about Sweden. Dr. Fotti, I was very impressed that it seems you are actually doing it on the ground, which I love seeing. You talked about various things, such as this “Patient's Medical Home”. I was talking with witnesses from Canada Health Infoway, who spoke about electronic health records. It seems that you are starting to use this technology in your clinic. You started talking about computerization and about sharing of information.
Could you explain a little more how you do that?
The other thing I want to ask you about is remuneration models in your clinic. It seems that you have all these different professionals perhaps looking at the same patient. In Ontario, there is a fee-for-service type of model. Are you guys doing anything different that seems to work?
Pritchard Farm Health Centre, As an Individual
In answer to your last question, we're fee-for-service at my clinic, but when we're doing our hallway consults, all it is is, “Dr. Boroditsky, can you come in and look at this rash with me?” We're not double-billing or anything like that.
When we are utilizing some of our doctors who have special interest in certain areas, that is more like a consultation, but the goal then would be that the outcome will be hopefully improved by our additional expertise in the area. But most of the time, if you see two or three of us going in a room, it's just an “I wouldn't mind having a couple of other opinions” kind of thing. It works quite well.
For our electronic records, nowadays it's purely not good patient care to start without it; that's for sure. Even now, as a business owner, understanding how much more efficiently we can keep track of things.... For example, it's so much harder to lose a test result: either it came into the system or it didn't. In the old days, you could have it falling out of the chart or being stuck in the wrong place and all that kind of stuff. It becomes a lot safer for the patients as well.
The only catch we have, and this may speak to some of the other comments about fragmentation, is that, for example, our electronic record can communicate with most other electronic records, but we have been having a lot of trouble because some of the electronic records that were adopted by the region can't communicate with ours. We still have to have all of them faxed over, converted into a PDF document, and put into the file, and then somebody has to go through it, whereas if the systems communicate properly, they can populate into the appropriate areas in the EMR and you have the information right there at your fingertips.
One of the other issues we have found is in wanting to link with something called eChart. The eChart allows access to all patient lab data that has come through the central system—all of their diagnostics, CT scans, X-ray reports, and everything.
They are deep in: we can access their drugs and immunization history and quite a few other things. It's very handy in the office. If you came in for your CT result and I said I didn't have it yet, I could log on, and it would probably be right there and we could get it for you.
The catch is—we are working with them now to implement it—that their technology is so old that to implement it for our clinic, they have to come in and actually downgrade our Internet and whatnot so that it will work with our system. Now we're not sure, because if we do this, we might have issues integrating with our X-ray department. We may have to downgrade just one or two stations to older technology to use this program.
It would be nice if the technologies worked together in a more collaborative way. It is very fragmented in that way, unfortunately.
November 29th, 2012 / 12:20 p.m.
Conservative
Wladyslaw Lizon Conservative Mississauga East—Cooksville, ON
Thank you very much.
I have two minutes, so I'll ask the question quickly.
I have a question for Dr. Bohm. It's not directly connected to your presentation, but what I want to ask you is more on the technical side about knee and hip implants or artificial knees and hips. How have they developed over the years? Where are we heading? What would you like to see in the future for those implants?
Associate Professor, Concordia Joint Replacement Group, University of Manitoba
That's an interesting question. Thank you.
In the ideal world we would get to the point where we wouldn't have to do hip and knee replacements, where we can prevent the progression of arthritis. That would mean the early detection and treatment of osteoarthritis, and early detection and treatment of inflammatory arthritis, such as rheumatoid arthritis. If they get there, however, the ultimate goal would be to develop a hip or knee implant that patients are completely unaware of, that functions normally, and that lasts patients for the rest of their lives.
There are two main areas we look at now. In knee replacements—you may remember that data I showed you there—about 5% of knee replacement patients aren't happy with the result. It doesn't feel like a normal knee. It clicks and catches, and they have aches and pains. It's a bit unstable and doesn't feel like a normal knee. I think we have a lot of work to develop implants that feel more normal, particularly in knees. The other issue is longevity. These eventually wear out. I had some pictures showing broken implants and rod implants, so there's a lot of work being done right now to improve the bearing surface—that's what we call it—to improve longevity. We've made a lot of headway there.
The last issue that we have to deal with is the ongoing issue of infection. That is, infection at the time of the operation and even late infections five or ten years down the road. I think we'll be developing implants that help reduce the chance of infection. Those are the three main areas.
Conservative
Wladyslaw Lizon Conservative Mississauga East—Cooksville, ON
Where do we stand in comparison to the rest of the developed world?
