Primary Health Care in Ontario, Research Paper Example

Primary Healthcare in Ontario: Policy Paper on the History of Health Reform at the National Level and the Progress to Date in the Province of Ontario

Introduction

Prime Minister Jean Chretien appointed Saskatchewan Premier Roy Romanov in April 2001 as a one-man Commission on the Future of Health Care in Canada. Romanov reported directly to the Prime Minister and began working on the first day of May 2001 and the final report of the Commission was reported as being tabled in November 2001. (Munroe, 2002, paraphrased) Mr. Romanov was assigned the task of examining the long-term challenges of “maintaining public, universal health care system in Canada – including challenging demographics, rising costs and new technologies – as well as recommending government policies and programs to balance health maintenance with health care and treatment.” (Munroe, 2002, p.1)

Objective

Even as early as this past November 2011, the provinces has already began an informal process of negotiation with one another about what type of funding and conditions they want to see on the table in 2014. (Wingrove et al, 2011, p.1) All provinces will enter into discussions with the federal government shortly. As an analyst in Ontario’s Ministry of Health and Long-term Care, the writer of this work will research and prepare a policy paper that documents this history of health reform at the national level and the progress to date in the province of Ontario in Primary Care.

Romanov Commission

In November of 2002, following one and a half year of consultation and deliberation the Romanow Commission on the Future of Health Care in Canada delivered its final report, which contained 47 detailed recommendations. In reaction to the recommendations contained in the report, the Federal government engaged the provinces/territories in a series of agreements including; (1) the First Minister’s Accord on Health Care Renewal (2003); (2) Meeting on the Future of Health in Canada (2004); and (3) Specifically for the Aboriginal people the First Minister’s Meeting with Leaders of National Aboriginal Organizations. The ten-year Health Accord agreement that was struck in 2004 is up for renewal in 2014. At this point, the federal government has committed to just two things: (1) annual funding increases of 6% to 2016; and (2) a national agreement not to separate provincial agreements. Stated in regards to Primary Health Care by the Romanov Commission in terms of direction for change are that a breakthrough in implementing primary health care and transforming Canada’s health care system are at focus and that the Primary Health Care Transfer will be used as “the impetus for fundamental change in how health care services are delivered across the country.” (Romanov, 2002, p.115) Additionally it is stated that a common national platform will be constructed for primary health care “based on four essential building blocks”. (Romanov, 2002, p.115) Stated as well is a mandate for the proposed Health Council of Canada to hold a National Primary Health Care Summit for mobilization of action across Canada and that the momentum will be maintained by “measuring progress and reporting regularly to Canadians.” (Romanov, 2002, p.115) Furthermore, prevention and promotion will be integrated as initiatives “as a central focus of primary health care targeted initially at reducing tobacco use and obesity and increasing physical activity in Canada.” (Romanov, 2002, p.115) Finally, it is stated that a new national immunization strategy will be implemented.” (Romanov, 2002, p.115)

Fulfilled Promises

Promises made by the Canadian government that have been fulfilled:

(1) Diagnostic/Medical Equipment Fund – The Canadian government initiatives for the Diagnostic/Medical Equipment Fund. The provision of $1.5 billion over three years funding will provide support or equipment acquisition and installation and train staff specialization in improvement of publicly funded diagnostic services access and bring about a reduction in time spent waiting (Health Canada, 2004, p.1)

(2) Patient Safety – The Canadian Patient Safety Institute was established by the government in December 2003 for implementation of a national strategy focused on safety improvement and quality of care (Health Canada, 2004, p.1)

(3) Health Council – this council was established for the purpose of monitoring and reporting on the Accord’s implementation (Health Canada, 2004, p.1)

(4) Comparable indicators – reporting of the government to the public regarding the health system and its performance as of January 2004 (Health Canada, 2004, p.1)

;(5) Compassionate Care Benefit – The Canadian government has fulfilled its promise in the Accord for establishment of a program that will better assist workers in leave from work to provide care for a loved one. The Compassionate Care Benefit began in January 2004 under Employment Insurance and provisions up to six weeks leave for Canadians who are eligible;

(6) Health Technology – agreement reached with Canada Health Infoway in March 2003 on electronic health records and common information technology standards development being accelerated with supporting $600 million funding(Health Canada, 2004, p.1);

(7) Official Language Minatory Communities – Canadian government in disbursing $89 million funding for a five-year improvement of access to health services in French and English language minority communities; (Health Canada, 2004, p.1) and

(8) Canada Health Transfer – This transfer replaces the Canada Health and Social Transfer, which was established April 1, 2004 by the Canadian government toward increasing transparency and accountability for health spending. (Health Canada, 2004, p.1)

Primary Care Analysis

In 2010 a report was published by the McMaster Health Forum stating that the overarching problem in Canadian primary health care is “…one of limited or inequitable access to sustainable, high-quality community-based primary healthcare in federal, provincial, and territorial funded health systems.” (McMaster Health Forum, 2010, p.5) It is reported that there has been “slow but steady (if uneven) progress in improving access to cost-effective programs, services, and drugs in primary healthcare environments and in adapting health system arrangements to ensure that they support the provision of cost-effective programs, services, and drugs in these environments. Nevertheless, Canadians’ access to cost-effective programs, services, and drugs is not what it could be and health system arrangements often do not support the provision of these programs, services, and drugs.” (McMaster Health Forum, 2010, p.5) The report states that there are four general messages relevant to implementations in primary health care and those stated are as follows:

(1) Primary healthcare initiatives must be flexible and locally relevant if they are to be implemented and achieve desired impacts. McMaster Health Forum, 2010, p.6)

(2) System-wide primary healthcare initiatives should start with functional/operational changes and then follow successes up with the organizational structures needed to support them. Said another way, policymakers and stakeholders should be searching for functional solutions initially, not structural solutions. McMaster Health Forum, 2010, p.6)

(3) Supportive and visionary leadership can facilitate change for the better related to any of the options. McMaster Health Forum, 2010, p.6)

(4) Changes in Canada’s health systems are rarely fast, so policymakers and stakeholders promoting or leading primary healthcare initiatives require patience and long-term commitments. (McMaster Health Forum, 2010, p.6)

It is additionally noted in the report that primary healthcare policymakers and stakeholders “need to become better at leveraging existing strategies and targets, such as waiting time initiatives, by demonstrating how strengthened primary healthcare systems can support the implementation of these strategies and the achievement of these targets.” (McMaster Health Forum, 2010, p.6) Additionally stated is that primary healthcare initiatives need to “…be better aligned with other policy initiatives, such as chronic-disease management, aging at home, and long-term care, among others, and that the role of primary healthcare in each of them needs to be more clearly articulated. Said another way, they argued that primary healthcare needs to be mainstreamed (i.e., integrated) into all healthcare policies.” (McMaster Health Forum, 2010, p.6) Also noted was that monitoring and evaluation was missing in the majority of existing policy frameworks and implementation although these were considered to be of primary importance by many key informants. Informants held that monitoring and evaluation should not be “framed as accountability or reporting exercise, but rather as a process to support improvement.” (McMaster Health Forum, 2010, p.7) It is noted that it would be possible to motivate providers and managers through providing them with “knowledge, tools, and resources.” (McMaster Health Forum, 2010, p.7) Additionally reported is that there is a “great variation in primary healthcare systems across Canada and a lack of a common vision for a primary healthcare system.” (McMaster Health Forum, 2010, p.7) Primary healthcare systems in Canada are reported to be “underperforming relative to the systems in most of the countries” to which Canada generally compares itself. (McMaster Health Forum, 2010, p.8) The primary healthcare system in Canada is reported to be not financially sustainable and therefore should not be sustained in their present state since they are failing in delivering the quality of care and outcomes expected by Canadians. (McMaster Health Forum, 2010, paraphrased) It is reported that Canada needs “a national patient-centred primary healthcare strategy y that is supported by high-level political leaders…” (McMaster Health Forum, 2010, p.8) It is stated that there is synthesized research evidence available and that this should be used for informing decisions concerning the required “common structural features, as well as later decisions within each publicly funded health system about those structural features that meet unique local needs and are well-suited to unique local contexts.” (McMaster Health Forum, 2010, p.8) It is reported that the key informant interviews along with documentary analysis supports six specific features in primary health care which include: (1) self-management support or empowerment of patients in managing their own health and health care; (2) decision support through promotion of clinical care consistent with scientific evidence and the preferences of patients; (3) delivery system design that is proactive and culturally sensitive in delivering effective and efficient clinical care combined with self-,management support and inter-professional teams; (4) clinical information systems including electronic records with build in timely reminders for providers and patients; (5) health system supports; and (6) community resources in terms of mobilization of resources geared toward meeting the needs of patients. (McMaster Health Forum, 2010, p.9)

Analysis

As noted in the previous section of this work in writing the Canadian Government has fulfilled many of the promises that it made in regards to the administration and implementation of health care of health care services with reduced waiting times, and enhanced by state-of-the-art equipment provision in Canadian hospitals and clinics. Ontario is reported to have access to primary care providers while many others in the population do not have a doctor.” In a separate report, it is stated as follows: “A larger percentage of Ontarians have access to a primary care provider, but 6.5% of the province’s population don’t have a family doctor, 3.3% are actively seeking one and half the people who are referred to a specialist wait four weeks or longer for an appointment. Primary health care in Canada has improvements that are needed in terms of empowering patients in self-management of their own health care. Additionally found is the need for a model of primary health care due to the variations in primary health care models across Canada. Electronic records access needs are also cited in the reports review in this study.

Bibliography’ Acc

2003 First Ministers’ Accord on Health Care Renewal (2003) Health Canada. Retrieved from: http://www.hc-sc.gc.ca/hcs-sss/delivery-prestation/fptcollab/2003accord/index-eng.php

First Ministers’ Meeting on the Future of Health Care (2004) Health Canada – Health Care System. Retrieved from: http://www.hc-sc.gc.ca/hcs-sss/delivery-prestation/fptcollab/2004-fmm-rpm/index-eng.php

Strengthening Primary Healthcare in Canada (2010) The McMaster Forum – Issue Brief. 8 Jan 2010. Retrieved from: http://fhswedge.mcmaster.ca/healthforum/docs/Strengthening%20Primary%20Healthcare%20in%20Canada_issue-brief_2010-01-08.pdf

Munroe, Susan (2002) The Romanow Commission on Health Care in Canada. About.com Canada online. Retrieved from: http://canadaonline.about.com/od/healthcarecanada/a/romanow-commission-health-care-canada.htm

Quality Monitor (2011) Ontario’s Health Quality Ontario, Retrieved from: http://www.ohqc.ca/en/yearlyreport.html

Report on Ontario’s Health System (2012) Ontario Health Quality. Retrieved from: http://www.ohqc.ca/en/index.html

Romanow, Roy. G. (2002) Building on Values: The Future of Health Care in Canada. Commission on the Future of Health Care in Canada. National Library of Canada. Retrieved from: http://publications.gc.ca/collections/Collection/CP32-85-2002E.pdf