Course:DHYG404/groupone2009

DHYG 404 - Group 1

BLOCK 4

Hey Group 1! Here is what I have so far for question 1. I am having some trouble answer question 2 because it seems like we are unable to properly answer question 2 with the three resources provided since it does not mention anything on oral health. Let me know what you think!

Bruce

1. How do the values embedded in international HC systems compare to the values expressed in our Canadian system? (ie: what are the similarities and differences that you found in terms of values)?

Similarities •Sweden also follows a national health insurance/single payer model in their health care system (1)

Differences •In European countries there is a strong ethic of social responsibility within their culture, therefore their fundamental goal in their public health care system is to protect and promote the “public interest. (1) - European healthcare vision of “solidarity, mandatory participation, strict public regulation, community-based fairness and health valued as a social good.” (1) - European HC Focus on micro-economic efficiency “based on the idea that competitive reforms tempered with the ideals of solidarity can still increase efficiency” (1)

2. How is oral health integrated in to the HC system of different international countries and how does this compare to our Canadian approach? Again, this will be at a fairly high level perspective…I’m not expecting to see a micro level analysis of every foreseeable dental procedure incorporated in to a particular country’s HC system for this Block activity, although you are free to point out specific examples if that will help support the point(s) you are trying to make with regard to a Canadian comparison.

1. International Healthcare Systems Primer PDF available at http://www.amsa.org/uhc/IHSprimer.pdf

Hi Everyone I couldn't access the second reading for some reason, so have just based my thoughts on the first reading ("Health Care Systems in Eight Countries; Trends and Challenges). I based my findings on the following values: comprehensiveness, universality, portability, accessibility, and public administration. These are the summarized similarities and differences I found. There was a ton of info to churn through, so if you think I'm wrong then feel free to disagree! For question 2 I think we can look a bit more at the specific countries that do cover dental treatments and compare that to Canada. They are all mentioned below. If someone in the group hasn't already worked on question 1 maybe you could focus on question 2. Cheers, Tanya

Similarities

Australia – universal access to care regardless of ability to pay Dental treatment and ancillary treatments (physio, massage etc) not covered Public funding (taxation) and administration Optional private insurance Wait list system Shortages of health professionals in some areas Ggeographic and cultural barriers to the use of health services Differentials in health status between Indigenous people and other Australians

Denmark - universal access to care regardless of ability to pay Public funding (taxation) and administration Optional private insurance

France – universal access to care regardless of ability to pay Public funding (some taxation) and administration Optional private insurance Difficult to find doctors to practice in some rural or suburban areas

Germany – optional private insurance Difficulties with private medical data storage and access

The Netherlands - optional private insurance available

New Zealand – public funding (taxation) Regional funding and delivery Optional private health insurance Adult dental care not covered Free public hospital care Working on public participation, quality of care and cultural sensitivity

Sweden – health care system based on human rights, need or solidarity, and cost-effectiveness Adult dental care not covered Wait list system A shortage of physicians in isolated rural areas Concern regarding capacity, quality and cost containment

The U.K. – universal access to care regardless of ability to pay public funding (taxation) Optional private insurance Most diagnostic procedures are carried out at general hospitals Wait list system

Differences

Australia – two tier system, those who can afford to pay for private are allowed Government pharmaceutical coverage Dr’s can charge more than the fee schedule and bill patients directly Private insurers must accept all applicants Most diagnostics done by private providers Tax rebate system for taking out private insurance

Denmark – The costs of physiotherapy, dental care and pharmaceuticals prescribed in a primary care setting are partially covered by the statutory health care system. Waitlist guarantee system in place Must register with a GP and can only change every 6 months

France – employer and employee funding All residents are automatically affiliated to a health insurance scheme on the basis of their professional status and place of residence. Dental coverage included in public system User charges not fully reimbursed e.g.: a portion of the charge for GP and specialist visits, drugs, and lab tests

Germany - responsibilities for health are shared by the federal government, the Länder and corporatist bodies, administration is via private and public bodies Not everyone is covered by public health – high income earners can opt out Dental care and drugs are included in public health care coverage Uses sickness funds Income-based social health insurance contributions (not taxation based) shared equally between employer and employee Cost sharing Dental coverage Around the clock medical services (not hospitals) Referral required for hospital access (except for emergencies)

The Netherlands – not universal access except for long-term care and high-cost treatments Funding via public universal insurance (employer/employee contributions); compulsory social health insurance for the low income and voluntary private health insurance for the high income; and voluntary supplementary insurance open to all (minimal via taxation) Sickness funds cover low income including dental and pharmaceutical coverage Health Insurance board administers contributions Guaranteed access to care (waitlists violate patients’ rights – although in reality there are still waitlists) Entirely private diagnostic services

New Zealand – not universal access except for hospitals (uses a co-payment system) Accident Compensation Corporation covers 100% of accidental injury/work injury Free dental care for children Co-payment system for pharmaceuticals No private care in public hospitals Mostly private diagnostic/lab services Waitlists are not a big problem

Sweden – funding from county councils and municipalities (local taxation) Almost no private insurance Free dental care to age 19 Compulsory social insurance premiums for employed Co-payment system Basic diagnostic and lab services available at primary health centers

The U.K. – user fee for dental, pharmaceutical and optical up to a maximum rate Working on an integrated electronic health record

Hi Group 1! Here is what I have so far. Lana

1. How do the values embedded in international HC systems compare to the values expressed in our Canadian system (ie: what are the similarities and differences that you found in terms of values)?

Similarities: •European countries: Strong ethic of social responsibility; “vision of solidarity, mandatory participation, strict public regulation, community-based fairness, and health valued as a social good”. (2) •Australia: Access, equity and quality issues are monitored. System is not ideal-long waitlists. (1) •Sweden: Single-payer system; wait times are a problem; capacity to ‘deliver care is being strained by a rapidly aging population’ (2) •France: Values of solidarity, universal care, collectivity balanced with respect for freedom and individual choice. Public care. (2) •UK: Public delivery, single-payer system; guided by principles of equity, comprehensiveness and free access at the point-of-service. (2) •South Africa: Publicly funded. Main system of delivery is public with a growing private sector. (3) •Brazil: Publicly funded system. (3)

Differences: •Australia: Both private and publicly funded. (1) •Sweden: 3 basic principles for care in order of priority-human rights, need/solidarity, cost effectiveness. (2) •Japan: Multi-payer national health insurance system; hospitals exist overwhelmingly in the private sector (mostly owned by physicians, for profit). (2) •Netherlands: Hybrid public-private healthcare system; majority of hospitals are private, non-profit. In order to address waitlist issues, sickness funds have contracted with other countries to provide care for enrolees. Hospitals paid according to performance levels and ability to meet goals aimed at reducing wait times. (2) •France: Multi-payer insurance system. (2) •Germany: Both public and private. (2) •US: Heavy reliance on private, voluntary insurance. Both for-profit and not-for-profit private insurance companies; health services delivered in both public and private settings, with a predominance of physicians and hospitals in the private sector. ‘Quick access to cutting edge technology and a plethora of innovative treatment options, but not to all of its citizens’(not accessible to everyone). (2) •China: Public and privately funded, care delivered privately and public non-profit. (3)

2. How is oral health integrated in to the HC system of different international countries and how does this compare to our Canadian approach? Australia: Dental care excluded from Medicare. (1) Denmark: Dental care partially covered by the statutory health care system. (1) Sweden: Partial coverage restrictions apply to particular age groups, although dental services are fully covered until the age of 19 under National Health Service. (1) Netherlands: Sickness funds act covers selective dental care; private insurers often cover additional dental care. (2) Germany: Health system provides many benefits, including dental care. Easy access to dental services. However, there are different levels of cost-sharing. (2) Preventive dental care does not require any co-payment. (1) UK: State financed public oral healthcare system within the National Health Service (NHS). Often, basic treatment is carried out within NHS and more advanced treatment privately. All oral healthcare within the NHS is free for those under 18 years, students under 19 years, pregnant mothers, unemployed, low-income persons and inpatients in hospitals. Various companies sell private insurances. (4) Other NHS consumers pay 80% of dental care, up to a cap to GBP 354. (2) There is a charge of GBP 4.76 for a dental check-up (1) France: General dental treatment is covered within the public health system. In the case of more specialised treatment, generally neither the social security system nor voluntary health insurance will meet all of the costs. (5) New Zealand: Dental care is free for children; government pays only for urgent dental services on a means-tested basis for adults so most pay for their own dental care. (1)

References: 1. European observatory on health care systems. Health care systems in eight countries: trends and challenges. London; c2002 [cited 2009 Sep 30]. Available from: http://www.euro.who.int/document/OBS/hcs8countries.pdf 2. Hohman JA. International healthcare systems primer. The American Medical Student Association. No date [cited 2009 Sep 30]. Available from: http://www.amsa.org/uhc/IHSprimer.pdf 3. CBC news. International health care: How is health care paid for and delivered in other countries? c2009 [updated 2005 June 8; cited 2009 Sep 30]. Available from: http://www.cbc.ca/news/background/healthcare/intl_healthcare.html 4. WHO oral health country/area profile programme. United Kingdom: Oral health care system and services. Sweden; Malmo university; no date [cited 2009 Sep 30]. Available from: http://www.whocollab.od.mah.se/euro/uk/data/uksyst.html 5. Internet French property. Dental care in France [homepage on the Internet]. No date [cited 2009 Sep 30]. Available from: http://www.french-property.com/guides/france/public-services/health/dental/

_________________________________________________________________________________________________________________________________________________

Hi Group 1: Hi group - see below all our work for the summary - it is at 488 words, so it is not too bad for word count. I am also posting the document as a word document in our group 1 discussion area as I don't like how the Wiki program changes the format of the original text. Take a look at the word document as the headings make much more sense there. I'll be checking in late this evening. Martha

I've just read through the document and thought I would share my first thoughts on how to address the question: "What are the key strategies we need to incorporate/implement to align our health care system with the needs and value of Canadians?"

Romanov states that Canadians believe in equality, fairness, and solidarity. We believe it is a right of citizenship to have equal and timely access to health care. Health care sustainability to the average Canadian means, "Will medicare be there for me when I need it?" (Romanov)

I think the Romanov's proposals are very good, and take into account Canadian needs and values as well as the need to change our system to adapt to the current issues of healthcare (finances, prevention, education, diagnostic services, to name a few).

With this in mind, my thought is that we need to look at this problem in a twofold manner, that must be addressed simultaneously. We must address problems for Canadians NOW, and incorporate strategies that the problems of today do not overload the system and jeopardize public health care for Canadians of the FUTURE.

Key points that must be addressed NOW: -efficient public access to diagnostic services (equality) -effective care for rural populations (equality) -expand public health care to include home care services (more cost effective) -Health Council of Canada to measure and track performance and report to Canadians (accountability)

Key points that must begin action now to protect future generations of Canadians (including the above) -more educated health workforce, with greater delegation of duties (cost effective treatment) -focus on prevention, early diagnosis and treatment (cost effective, increased quality of life) -new pharmaceutical drug policies (equal access to drugs)

Well, this is just a start!! Let me know what you think of this format. Its just one way we could propose our argument. Martha

Hi everyone, Nicole here (or does that show up on the wikipage when you look at it?) I'll attempt to add here, some draft thoughts for the NOW part of our two-fold answer (see discussion page for my earlier post if this doesn't make sense)

Strategies to implement NOW to re-align Canadian HC system with Canadians values and needs:

1. Expand coverage and create target funds i) target fund for diagnostic servies would expand Medicare to cover all Canadians for medically necessary diagnostic services. This supports the principle/value of equality of services based on need, not money. ii) target fund for to cover priority home care services. This also supports the value of comprehensiveness and addresses equality as well as addressing the issue of cost savings iii) target fund for rural & remote access and include funds to ensure skilled HC workers are available to all communities. iv) target fund for catastrophic drug coverage to ensure that no families experience severe hardship or bankruptcy due to expense of medications required to treat illness.

provinces/territories would be required to provide financial accountability statements to assess the effectiveness and proper use of these target funds.

Additionally, immediate strategic actions could include: 1) expanding telehealth servicdes to continue to link patients with information and HC providers 2) expand home care coverage to inlude palliative in home services for those in their last 6 months of life 3) maintain & continue to expand the trend towards health promotion and prevention by focussing on keeping or returning phys ed & healthy lifestyle classes in schools as well as anti-smoking & drug use.

These are my initial thoughts to use for our submission. I won't be online again until late tomorrow night or early Wednesday. thanks, Nicole

Hi everyone. It's Zahra. Here are my thoughts

- Ultimate goal: to “transform medicare into a system that is more responsive, comprehensive, and accountable to all Canadians” -Objective “making Canadians the healthiest people in the world” -Equality and timely access to medical services is an integral part of our citizenship -“Canadians are the shareholders of the public health care system”

Issues: -individuals in remote areas cannot always access medicare when they need it -Mismatches between supply and demand: unacceptable times for some medical procedures

-The focus for the FUTURE should be on improving the overall sustainability of medicare while meeting the public’s needs by:

1) Making technological advancements such as electronic health records which would help to increase efficiency and decrease costs. This would help to improve our value for comprehensive care by making it easier for interdisciplinary health care professionals to collaborate and provide holistic care for each patient

2) Incorporating a funding program that is stable where funds can be directed toward health care reform initiatives so that the system can continually improve as the public’s needs evolve

3)Addressing the health care disparities such as access to care for Aboriginal peoples

4) Broadening the parameters of medicare to include programs centred around home care and strategies for drug therapy

5)Involving the public in decision making processes to improve satisfaction and meet the public’s needs. Emphasize collaborative leadership to improve accountability among shareholders in our health care system. Improve information sharing so that Canadians are more informed about how the system of medicare is being run. An open information system will enable governments and health care providers to take ownership of their role in the system

6)Making the health care system more transparent to increase efficiency in decision making and so that the system is more inclusive to the stakeholders involved…this can allow for more satisfaction since everyone’s voice can be heard

7)Placing greater emphasis on prevention…this would help fulfill the objective for having healthy Canadians and allow health care expenditures to be conserved or designated to other areas of need.

8) Incorporating more education and community health initiatives to inform the public about how to promote health and prevent disease and address the root of health care problems. Spend less time and money encouraging large radical changes to the health care system such as an increase in privatization which does not address the root of the problem. If long wait times are ultimately encouraging clients to seek private care where they can buy a service, address this problem by increasing supply to service the increased public demand. Educate more doctors, and broaden the scope of practice of various health care providers. For example, more health care provides should be able to perform simple diagnostic procedures. Finally, insure diagnostic procedures. All of these initiatives would help maintain and renew the principle of equity

9) We have “13 clearly separate health care systems, each with differing methods of payment, delivery and outcomes…”…therefore we must find a way to unify the system. For example, medical services should not be provided on a pay basis in one province and then be available free of charge in another province. Furthermore, rules for the provision of care and scope of practice should not vary among provinces or jurisdiction ….the provision of care and access to care should be standardized and equitable.

Zahra

Nicole's comments on above: Hi all, I think Zahara's points are good but want to add the importance of educating HC providers to align with needs of HC system. THis would go under FUTURE thoughts I believe......expand & recognize scope of practice of some HC providers (e.g. RDH's)so that well-educated professionals are not underutilized and health care needs are met(e.g. allow RDHs to Rx antibiotics for prophy where appropriate)

Also, who is good at condensing info? I am quite wordy by nature and not very focussed right now as I'm still in Hawaii.....who can prepare our submission for Thursday? (or Friday if it's changed) And, how is the Wiki page easier? Am I missing the point of it, am I typing in the wrong section? help.......? thanks,Nicole

Carrie Hello Nicole, Martha, and Zahra

I have finally figured out how to get into the wiki to type. I didn't have the page expanded so the login didn't show. I could see your work but I couldn't type..lol. I also think that our biggest challenge will be to condense our thoughts. I will post later tonight. I haven't seen a note from RC but I think our submission is not due until Friday midday as most of the class seemed to prefer this.

ttyl, CDP

What are the key strategies that we need to incorporate / implement to align our health care system with the needs and values of Canadians? Carrie's thoughts:

I basically agree will all that has been said but I fear that dividing up the Now and the Future stuff into two sections may be somewhat repetitive as some of the ideas overlap. I like Martha's idea but we have to be aware of the 400 wd maximum.

One important area that has not been addressed is the threat of globalization on our Health Care System and our values. See below (Romanow, 2002):

RECOMMENDATION 44: Federal and provincial governments should prevent potential challenges to Canada’s health care system by: • Ensuring that any future reforms they implement are protected under the definition of “public services” included in international law or trade agreements to which Canada is party; • Reinforcing Canada’s position that the right to regulate health care policy should not be subject to claims for compensation from foreign-based companies. RECOMMENDATION 45: The federal government should build alliances with other countries, especially with members of the World Trade Organization, to ensure that future international trade agreements, agreements on intellectual property, and labour standards make explicit allowance for both maintaining and expanding publicly insured, financed and delivered health care. 253

I might summarize as follows: Globalization may threaten our Health Care system through the "brain drain" phenomenon as other nations compete for health professionals and through challenge to international trade agreement by foreign health service enterprise. We must review our practice of recruitment and licensure of foreign health professionals; build alliances with other nations to ensure "health" is established as a foreign policy goal; and be cautious in health policy changes that allow for further privatization. Further privatization would open the Link titledoors to foreign competition under current trade agreements, undermine the positive economics associated with the provision of health care in Canada (i.e. money spent in Canada stays in Canada), and potentially undermine our social policy priorities.

I would also add a little to the electronic health record bit: EHR allows for evidence-based decision-making, transparency, helps to set priorities for health; privacy also becomes a big issue. (as an aside: the thought of a foreign country providing health care and having access to my EHR is scary to me especially in light of all of the identity theft. It is scary enough just having a national EHR).

We should also say something about addressing health disparity in Canada and cultural sensitivity (e.g. Expansion of Aboriginal Health partnerships)

Retrieved from "http://wiki.ubc.ca/Talk:Dhyg404groupone2009"

I can also edit later tonight after Martha has a first "go" at it.

Group 1 (Romanov) : Nicole Fisher, Carrie De Palma, Zahra Walji, Martha Szczepulski "What are the key strategies we need to incorporate/implement to align our health care system with the needs and value of Canadians?" Part I: What are the needs and values of Canadians? (Romanov) • Beliefs: equality, fairness, and solidarity • It is a right of citizenship to have equal and timely access to health care • Health care sustainability to the average Canadian means, "Will medicare be there for me when I need it?" • Ultimate goal: to “transform medicare into a system that is more responsive, comprehensive, and accountable to all Canadians” • Objective: “making Canadians the healthiest people in the world” Our group looked at the issues in a twofold manner. We must address problems for Canadians NOW, and incorporate strategies to ensure public health care is not jeopardized for Canadians of the FUTURE. Of course, there is considerable overlap in these points. The generality is that key points to address NOW are primarily access issues of today’s Canadian population. Key points for the FUTURE include access, but also greatly consider prevention, accountability, and above all, sustainability. Part II: Key points to address NOW to target the mismatch between supply and demand. • efficient public access to diagnostic services (equality) • effective care for rural populations (equality) • expand public health care to include home care and palliative services (more cost effective) • Health Council of Canada to measure and track performance of health care and report to Canadians (accountability) • Expand coverage and create target funds for diagnostic services (equality), home care services (comprehensiveness, equality), remote and rural access (equality), catastrophic drug coverage. Financial accountability of target funds required. • Expand telehealth services • Addressing cultural sensitivity and access to care disparity for Aboriginal peoples • Promote healthy living and prevention Part III: Key points that must begin action now to protect FUTURE generations of Canadians focus primarily on improving health of Canadians holistically (physical, emotional, spiritual), while at the same time forming a sustainable health care system. • more educated health workforce, with greater delegation of duties (cost effective treatment) • focus on prevention, early diagnosis and treatment (cost effective, increased quality of life) • A funding program where funds can be directed toward health care reform initiatives (system improvement as public needs evolve) • Involving the public in decision making processes (meet public needs) • Emphasize collaborative leadership (improve accountability) • Improve information sharing and transparency (accountability) • Initiatives to prevent medicare privatization (a two-tier system is not a Canadian value) • We have “13 clearly separate health care systems, each with differing methods of payment, delivery and outcomes…”… find ways for system unification. • Electronic health records (allows for evidence-based decision-making, transparency, helps to set priorities for health o Patient privacy must be protected • Counter negative effects of globalization on Canadian health care (through the "brain drain" phenomenon as other nations compete for health professionals) o review our practice of recruitment and licensure of foreign health professionals o build alliances with other nations to ensure "health" is established as a foreign policy goal Retrieved from "http://wiki.ubc.ca/Talk:Dhyg404groupone2009"