Evidence of meeting #75 for Health in the 41st Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was system.
A recording is available from Parliament.
4:15 p.m.
Conservative
David Wilks Conservative Kootenay—Columbia, BC
Thank you, Ms. Chair, and thanks to the witnesses for being here today.
I'm from the southeast corner of British Columbia in the IHA region. You can feel sorry for me if you like. I was a member of the board of directors of the East Kootenay Foundation for Health as part of the regional district of East Kootenay, so I'm somewhat familiar with IHA and its delivery of primary health care in the Elk Valley, specifically to Sparwood, which lost its hospital in 2005 and went to a primary health care model.
Doctors have been in and out of that system throughout those years. It's been very hard to continue to retain them. Whether it be through the increase of taxation locally and a number of innovations that we did to try to keep them there, nothing worked. Once the incentive was gone, they were gone.
So I'm not one to think that taxation works because, as the mayor of that community for six years, I personally have seen it not work. What I did see work was once the primary health care model went to an opportunity to provide patients with things they could do to improve their health to avoid such problems as diabetes or obesity. A lot of those programs are provided within the primary health care model in Sparwood, anyway.
A lot of those things are found through electronic technology that we have that wasn't available even 10 years ago for that matter. What type of technology do you see in the future that is going to aid rural Canada with limited opportunities for physicians and/or nurses, for those clients who need to have access to the medical facilities they can't readily get to?
4:15 p.m.
President, Public Health Association of BC
That is a tough question. I think that e-health and telemedicine hold a lot of promise. Some of that has been piloted and tested in British Columbia and other parts of the country. I don't know much about that, not having been involved in it myself, but I do think that is one thing that will make a difference. In the Interior Health Authority in British Columbia, I think there's been some very interesting innovation in primary care with the integration of nurse practitioners into fee-for-service family practice. That has had some very powerful effects in reducing ER visits and hospitalizations, improving chronic disease management, and providing opportunities for people to have access to a primary care provider that they previously hadn't had. Those were all in rural settings. That isn't technological innovation in the sense of e-health and telemedicine, but it is innovation in service delivery. I think Interior has provided some leadership in that, and the rest of the country could learn from it.
4:20 p.m.
Board Member, Canadian Doctors for Medicare
Thank you for the question, Mr. Wilks.
I've had some experience working in isolated communities. As a resident I spent a few months in Moose Factory, a community on James Bay. The technological tools that we used to access some specialist input were telehealth and telemedicine.
I also want to get back to your initial concern because I think it's a valid one. That's the shortage of health care professionals in rural communities. Telehealth is one of the best practices we can use to meet this demand. Studies have also been done, and I'm happy to connect you to them afterwards. To increase the health of the workforce in rural populations we need to also start recruiting medical students and future physicians who are from those communities. I think those are certainly other best practices we can share among our medical education systems across the country.
4:20 p.m.
Conservative
David Wilks Conservative Kootenay—Columbia, BC
If I could interject on that, Madam Chair, that sounds good in theory, but if you have a doctor who has just come out of school, it's highly unlikely that they want to practise in a rural setting, where they cannot under any circumstances practise their trade. I mean, they want to be able to have hands on, and I can assure you, at least in my area, that is not the case.
As we move forward, in 20 years from now, Dr. Raza, as we all age and we live longer—and I'm sure that everyone in this room would agree that we are living longer—what are some of the innovations that you see will assist us in having that population stay out of the hospital setting and stay in home care, that would lessen the burden on the entire system by home care?
4:20 p.m.
Board Member, Canadian Doctors for Medicare
One of the ones that I spoke about in my remarks, I think, is one that's moving in that direction. That's around providing better collaborative support for patients who have been recently admitted to hospital and who are frail, often elderly, who are at high risk for being readmitted to hospital. By setting up and putting more of an emphasis on community-based care, it helps keep them in the community as opposed to being readmitted to hospitals. That's important because it will save money, because acute care can be expensive, and it's also better care for the patients.
4:20 p.m.
Conservative
David Wilks Conservative Kootenay—Columbia, BC
What is the patient doing at home in this setting? How are they interacting with those—
4:20 p.m.
Conservative
The Chair Conservative Joy Smith
I'm sorry, Mr. Wilks, your time is up.
We have about five more minutes until we go to our business meeting, so we'll go into the five-minute round with Dr. Sellah.
4:20 p.m.
NDP
Djaouida Sellah NDP Saint-Bruno—Saint-Hubert, QC
Thank you, Madam Chair.
Before I get to my question, I'd like to make a comment, if I may. With all due respect to my colleague, Mr. Carrie, I found his questions about whether the witnesses were receiving money or not inappropriate. I just wanted to make that point, Madam Chair. Now, back to the topic in hand.
My question is for Dr. Raza.
I want to start by commending the two witnesses who are with us today. Their comments have been quite specific and relevant regarding the state of our health care system, a situation we are all very familiar with. They reconfirmed my impression of the health care system.
I know your organization considers the progress in primary health care reform less than significant. The issue was a key feature of the 2003-04 First Ministers' Accord on Health Care Renewal. Why do you think we haven't made much progress in reforming Canada's primary health care? What are the major barriers to that reform?
4:25 p.m.
Board Member, Canadian Doctors for Medicare
I can speak from my experience working in primary care in Ontario.
In Ontario there have been some moves towards new funding models in order to improve access to primary care physicians. Traditionally, family doctors and doctors in general are paid fee for service, so there's been a move to capitate it, which means that doctors are paid for the size of roster they have per patient, and then they're also paid a percentage on fee for service to see those patients.
Then there's another model, which is the model that I work in. I work in a community health centre. It's a model that Ms. Davies alluded to earlier. Here we're salaried, and we have a slightly different goal. Our goal is to work with a more high-needs population, patients who don't speak English or French as their first language, immigrants or refugees, the homeless population. We're encouraged to spend more time per patient, because they tend to be much more complex, and we have a higher complexity as a result.
It's recognizing that there's not a one-size-fits-all solution for marginalized populations. The community health centre is a great model. For other communities it may be something else. It's a willingness to have funding to try these new reforms in order to address primary care.
4:25 p.m.
NDP
Djaouida Sellah NDP Saint-Bruno—Saint-Hubert, QC
I have one last question.
Thanks to the input of all the witnesses who have appeared before us, we have learned that Canada is unfortunately a land rife with pilot projects. You may not know the answer to this. But what I'd like to know is how the government could take the lead in spreading these best practices to make sure that every Canadian, no matter where they live or how much they make, is able to benefit from those practices.
4:25 p.m.
President, Public Health Association of BC
I think that is a difficult question. Why have we not made progress? I think it's a very complex issue. There are many reasons why I do not think we have made a lot of progress.
Change is difficult. You have a system that's been developed and has benefited people for many years, both patients and providers. It's difficult to shift from what we know, from what has worked, to try new things. The mechanisms and structures have not necessarily been supportive of making those changes. There are vested interests in the system, and some of those vested interests are very powerful.
I know there is a shift in the demographics in the health care provider population. More and more women are getting into medicine. There is an increasing desire among some in that group to look at alternative funding models because they don't want to practise medicine or health care in the way that it has been practised in the past. But that is very difficult for them to do for all kinds of reasons. Again, it's vested interests in the system.
I think everybody has the interests of the population in the communities and their patients' best interests at heart, but I just think it's very difficult to make those changes.
Again, I think it's the role of the federal government to take leadership in convening provincial and territorial governments to come to some agreements. That may be difficult, but I think it is important for the federal government to take some leadership in that.
4:30 p.m.
Conservative
The Chair Conservative Joy Smith
Thank you so much to both witnesses.
Just for your knowledge, one of the reasons we have done the innovative technology study is that we're trying to get a big report out that will show best practices across the country. We're also trying, all of this committee, to think outside the box. It is a very complex issue, as you say.
As you say, Dr. Raza, one size doesn't fit all. It depends on whether it's remote, whether it's urban; it also depends on the populations. Many variables come into play.
I think we all agree that this is a difficult, complex situation that we're looking at together. We appreciate your coming today.
4:30 p.m.
NDP
Libby Davies NDP Vancouver East, BC
Madam Chair, I'd like to make a point of order.
I know that you're thinking the time for witnesses is coming to a close, but we haven't had a full round of everybody asking questions. Conversely, we don't usually have an hour for committee business.
I'd like to suggest that in order for more questions to be put to the witnesses who have come here today, including Dr. MacDonald, who has come all the way from B.C., we go for maybe another 20 minutes. We'll still have time for committee business. I don't think the bells will start until 5:15 p.m.
It's unusual that we wouldn't have a full round of questioning. We've done that for all other panels, so I'd like to suggest that we continue on. I'm sure we'll have adequate time for committee business as well.
4:30 p.m.
Conservative
The Chair Conservative Joy Smith
In actual fact, we haven't done that for every witness. We haven't had two full rounds. We're—
4:30 p.m.
Conservative
The Chair Conservative Joy Smith
Excuse me, but could I finish, please, Ms. Davis.
We haven't done the full-full round. We've made sure that everybody from all sides has had questions. What we need is to have the committee business, which we have started in other meetings and we have not finished. Today was more conducive to doing that, because we only had two witnesses.
But I'll take it to committee. Let's just see what everybody thinks.
Mr. Brown.
4:30 p.m.
Conservative
Patrick Brown Conservative Barrie, ON
We have early bells today too with votes at 5:45 p.m., so I note that we would not have an hour; we'd barely get half an hour to have committee business.
4:30 p.m.
Conservative
4:30 p.m.
NDP
Libby Davies NDP Vancouver East, BC
Recognizing that the bells are going to ring at 5:15 p.m., which is kind of weird because committee doesn't technically finish until 5:30, but that's a matter for whips, my suggestion is that we go to 4:40 p.m. and that way we'll still have 25 minutes for committee business. Sometimes we've done committee business in five minutes. Very rarely have we done an hour of committee business. What I'm aware of in terms of committee business I can't imagine that it's going to take 45 minutes or an hour. It just doesn't seem fair that we don't have at least one full round of questioning for the witnesses who are here which we normally would do.