Global
Gl
b lT
Trends
d iin
Health Care Reform
Recent Canadian Developments
Michael Decter
Annual Research Meeting in Boston
June 28, 2010
Recent Canadian Developments
1
1.
2.
3
3.
4.
5.
Fiscal Sustainability
Existing Financial Arrangements
Options
Political Debate
Provider Organization
Elderly Care Services
Pharmaceuticals
Conclusions
2
1 Fiscal Sustainability
1.
•
•
•
•
•
Canada less impacted than other G-8
G 8 nations by recession
recession.
Canada has recovered 75% of jobs lost.
However there are large
g government
g
deficits and both national and
provincial government levels.
Restraint to restore fiscal balance will commence in 2010/2011.
Health care spending will be impacted by provincial government
efforts to cost contain to restore balanced budgets in 2010/2011.
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Existing Financial Arrangements
•
•
Health Accord of 2004 between Government of Canada and
Provincial Governments had ten year timeframe.
6% annual escalator on Federal transfers to provinces expires 2014.
4
Options
Options under limited public discussion include:
• Continuation of status quo with much lower wage settlements.
• Renewal of Federal Accord with lower annual escalation.
• Taxation of health benefits.
• Opening of private insurance options.
• Cost containment “bending the cost curve.”
5
Political Debate
•
•
•
•
•
Minority government with little likelihood of future majority.
majority
Health care politically difficult for current Federal Government.
Likelyy debate will remain at provincial
p
level for another 1 – 2 yyears.
Provinces will seek a unified position for negotiations over renewal of
2004 Health Accord.
Federal election will occur before next round of negotiation.
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2 Provider Organization
2.
•
•
•
•
•
Fifteen year trend towards regionalization reversed in two of ten
provinces (New Brunswick/Alberta).
In those provinces regions amalgamated into single provincial health
authority (NHS style).
Canada has moved very slowly away from solo practice family
physicians on “fee
fee for service
service” payment model.
model
Emerging models are family health teams with capitation and some
substitution of nurse p
practitioners and other p
providers for p
physicians.
y
Also some nurse lead clinics being established to bolster primary care.
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3 Elderly Care Services
3.
•
•
•
•
There are initiatives underway such as Ontario
Ontario’ss Aging at Home
initiative.
General focus is unclogging hospital beds by developing non-hospital
alternatives in enhanced home care and nursing home care.
Disease specific initiatives in diabetes are gaining attention.
C d llags other
Canada
h nations
i
iin organized
i d elder
ld care ffocus.
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4 Pharmaceuticals
4.
•
•
•
•
•
Major steps to reduce price of generic drugs (Ontario).
(Ontario)
Pharmacies under pressure to reduce margins (Ontario).
Emergence
g
of price
p
competition
p
between brand name manufactures
with patent expirations on major products and generic manufacturers.
Governments likely to facilitate competition and benefit from lower
cost for
f their
h i ddrug plans
l
(N
(National).
i l)
Ontario measures likely to be adopted across both public and private
sector drug plans.
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5 Conclusions
5.
•
•
•
•
Canadian health care debate over future directions will accelerate in
next two to three years.
Not likely to be an election issue among national party leaders.
Premiers will begin to position for re-negotiation of Health Accord.
Federal Government will put responsibility on provinces for reducing
h l h care costs.
health
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