You do, you have one minute.
Evidence of meeting #76 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.
Evidence of meeting #76 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.
4:50 p.m.
Conservative
Colin Carrie Conservative Oshawa, ON
Okay.
Just to continue with the demographic shift issue, we're not graduating enough gerontologists, for example, with what we're looking at over the next 20 years. Have you looked at the different pay models? Right now in Canada we have this pay-per-service—most doctors get paid by the service—versus salaries. Have you looked at different models that might be of benefit as we go through this demographic shift? As I said, can we start utilizing professionals who might be able to provide the services within their scope of practice much more cheaply for the provinces?
4:55 p.m.
Assistant Professor, Centre of Health Services and Policy Research, University of British Columbia, As an Individual
I'll condition my statements on not being an expert in health human resources, but I know that there are opportunities to change the mix of trained professionals providing health care. However, at the same time, a lot of the costs being driven by the aging baby boomers, for example, are driven by the increasing intensity of the health care services provided. For example, we have new and innovative diagnostic techniques, new and expensive therapies, and also devices. These are increasing the costs as well as the aging of the population, so I think we have to view it in the frame of several different cost drivers there.
4:55 p.m.
Conservative
The Chair Conservative Joy Smith
Thank you, Dr. Carrie. Thank you very much, Dr. Sutherland.
We'll now go to Dr. Fry.
4:55 p.m.
Liberal
Hedy Fry Liberal Vancouver Centre, BC
Thank you, Madam Chair.
I think the whole idea of collecting data and having a clearing-house is key to what you're saying, Dr. Sutherland.
I know that the whole HHR efficiency piece has not been tested at all.
Those are two big issues that were there in the 2004 model from the accord in which people were going to look at this and focus on it. For instance there are community care models—just to follow up on what Dr. Carrie was saying—and I know in places like Calgary they were using the multidisciplinary model of different HHR people to do appropriate care. As pilot projects, these community care groups were being rewarded based on the number of people they were able to keep out of hospital. So in fact they were freeing up beds in hospitals by doing this community...and mixing it with home care nursing. They were able to keep tabs on people and keep them well, keep them from getting so acutely ill they had to go to hospital, and using the appropriate caregiver.
Because they were given an incentive and rewarded at the end for the number of patients they kept out of hospital there was that incentive model.
The clinic I visited in Calgary had shown that they had a 25% drop in hospitalization rates. Do we have that information for any other such models that were started with the 2004 accord? Do you know about those? Have you been following them?
4:55 p.m.
Assistant Professor, Centre of Health Services and Policy Research, University of British Columbia, As an Individual
I believe there is some emerging evidence coming out of Ontario, the Institute for Clinical Evaluative Sciences, regarding their family health teams in Ontario. I'm not familiar with the evaluations and the results but I believe they are currently starting to emerge.
I know that for the Calgary group there aren't formal evaluations on the effectiveness of these interventions or the aggregations of providers. Nor are there evaluations of the new primary care teams that are being developed and implemented in British Columbia.
4:55 p.m.
Liberal
Hedy Fry Liberal Vancouver Centre, BC
They've been going now for four or five years? So you're back to data collecting again. We're back to the need for collecting information, data, etc., and disseminating it appropriately.
4:55 p.m.
Assistant Professor, Centre of Health Services and Policy Research, University of British Columbia, As an Individual
Yes, and I think there's definitely a role for—and I would lobby for—a national role that is able to quickly identify new and innovative cost-saving, high-quality, effective care and disseminate that quickly and assist the provinces in scaling that up quickly as well.
A lot of the innovations around the reorganization and delivery of health care don't have that evaluation. So we'll only know that it costs money but we won't have any outcomes associated with it.
4:55 p.m.
Liberal
Hedy Fry Liberal Vancouver Centre, BC
Why is it the U.K. model, which is looking at patient-reported outcome measurements.... For instance, vein ligation is not a massive intervention. Do you have any understanding of why they picked those very minor pieces rather than looking at some of the more costly interventions?
4:55 p.m.
Assistant Professor, Centre of Health Services and Policy Research, University of British Columbia, As an Individual
I think it was quite strategic in how they picked their procedures because they elected to choose preference- and supply-sensitive conditions and probably in surgical specialties where they had the least resistance or surgical groups who were trying to advocate for additional funding there. So I think that's on that triad of the different factors as to how they pick them.
Also, for them I think it is assessing whether or not they have the informational capacity to be able to link all the cost data, the hospitalization data, and now the patient-reported outcomes data. That they're now bearing fruit from this and able to discuss effectiveness at a population level is truly outstanding. Although we don't hear any rumblings of expansion of this program I certainly think it's something we should take a hard look at.
5 p.m.
Conservative
The Chair Conservative Joy Smith
Thank you so very much, Dr. Fry.
We've come to the end of two complete rounds. It would be my suggestion that we stop at this point unless the committee wants to continue. If you want to continue we could go through another round. But I'm not sure that everyone has a list of questions. What is the will of the committee?
5 p.m.
Conservative
The Chair Conservative Joy Smith
We'll go through the natural....
Are there any other questions?
Dr. Carrie?
We'll go through the second round.
5 p.m.
Conservative
The Chair Conservative Joy Smith
We'll do it properly or we won't do it at all.
So we'll go back to the seven-minute rounds, and we'll start with Ms. Davies.
5 p.m.
NDP
5 p.m.
Conservative
The Chair Conservative Joy Smith
We'll go to five minutes, okay, if you want. We'll just do one and one?
5 p.m.
An hon. member
One and one, yes, why don't we do that?
5 p.m.
NDP
Libby Davies NDP Vancouver East, BC
Yes, that's what I was suggesting.
The question I wanted to get at, Dr. Sutherland, is this. You've talked a lot about hospitals, and I just wondered if you are applying your research and the work that you're doing at the Centre for Health Services and Policy Research to other areas, such as primary care, for example. It seems to me that's a huge issue as well in terms of fee-for-service and how that whole model works, or rather doesn't work.
Then my added-on question is, who else is doing this research in Canada? It seems to be such a huge issue. Is it mostly through university settings and research centres that it's being done? I know you are funded by CIHR, but is there any other body that's doing it at the federal level? I'm just curious about how much we are into this. Or are you out there in this field breaking new ground?
5 p.m.
Assistant Professor, Centre of Health Services and Policy Research, University of British Columbia, As an Individual
I'll try to hit off the questions. I'm not an expert in primary care evaluation of interventions, especially on the service delivery side. I do know there are networks of primary care researchers across Canada. In British Columbia, Alberta, and the Maritimes, primary care research is very large. My focus of expertise is in community care. So that would be anything delivered out of the hospital that is not primary care, and funding models for those, plus also hospital-based care.
As you rightly pointed out, that's where my emphasis has been, with less discussion on primary care.
The other part is, there are very few researchers looking at funding policies and evaluating funding policies for health systems, and studying health system design effectiveness and interventions on them in Canada. I believe that there are only several CIHR-funded researchers in Canada in this area, and I would dearly love that there were more.
5 p.m.
Conservative
Colin Carrie Conservative Oshawa, ON
Yes, thank you very much.
And thanks again, witnesses.
Dr. Sutherland, first, I just wanted you to elaborate on this pay-per-service versus salaries. I have friends who are medical doctors, and for them to have a full roster of geriatric patients...each patient takes half an hour. So it's hard to make a living. Basically, with a pay-per-visit service you can only see maybe 16 patients a day if you're totally booked. Some of these patients even take longer.
So I was wondering whether you see any solutions that we can look at for pay-per-service versus salaries.
The other question I had was for Dr. Guirguis, about the bundled services, and I can see there's again a bias. I'm a patient, I want to go to your clinic. If you're going to provide that service for me, yes, OHIP will pay you as the surgeon to do it, but then in a hospital, the operating room would be paid for, the doctor would be paid, and then the nurses would be paid, the follow-up care in the rooms afterwards for two or three days, whatever it is, would be covered.
You're absorbing some of that right now, but with this whole idea of bundled services, do you think with your innovative model of delivery, if bundled services were more available, that you could save the system money? Are there efficiencies to be had in that type of situation?
It's Dr. Sutherland first, then Dr. Guirguis second, if that's okay.