Environmental Scan for Leaders- PEST and Health policy scan

Environmental Scan for Leaders: PEST and Health policy scan Dr. Kellie Leitch Contextual Backdrop for Health Policy Scan: P olitical E conomics S ocial T echnology PEST - Political Federal/Provincial/Territorial Elections Last Election Canada NL PEI NS NB QC ON MB SK AB BC YT NWT NT 2004 (minority) 2003 2003 2003 (minority) 2003 2003 2003 2003 2003 2004 2005 2002 2003 2004 Next Expected 2006 (following final Gomery report) 2007/08 2007/08 Spring 2006 2007/08 2007/08 2007/08 2007/08 2007/08 2008/09 May 2009 2006 2007/08 2008/09 Prime Minister’s Priorities  Challenges  Changing demographics of Canadian population  Rise of China and India  Priorities  Education  Commitment to innovation  Robust private sector investment Source: Office of the Prime Minister. Address by Prime Minister Paul Martin. September 20, 2005 Canadians’ Top Public Policy Concerns Surplus Spending Priorities  Health care  Post-Secondary Education 66% 46%  Cut Middle-class Taxes  Reduce Federal Debt  National Childcare Program  Environment (Kyoto) 39% 34% 45% 39%  Military/National Defence 27% Source: Ipsos Reid/G&M/CTV Poll Feb 21 2005 PEST - Economics PEST – Economics - The Basics... Canadian $ CPI (inflation) .8472 (US) 2.6% (Aug) Unemployment GDP Growth 6.8% (Aug) 0.2% (July) First Ministers’ Meeting & Federal Budget  “Deal for a Decade” >$40 B  New CHT base of $19 b in 05-06  PLUS $33B more in Equalization & TFF over next 10 years  $5B over 5 yrs - Child Care Initiative  Raise the basic personal tax exemption to $10,000  $805M over 5 yrs in health funding for HHR ($75M for IMGs), wait times, national health goals, medical equipment, enhanced preparedness for flu pandemics Key federal numbers  Federal debt - now stands at $499 billion -17 cents of every revenue dollar on interest on the public debt (down from the peak of 38 cents in 1990-91)  2004-05 - 8th consecutive annual surplus  Projected surplus for 2005-06 is $1.2 b (net of $3b contingency reserve - TD Economics)  Legislation for surplus:  1/3 spending priorities;  1/3 tax relief;  1/3 debt reduction Source: Dept. of Finance. Government of Canada records eighth consecutive surplus. Media Release September 21, 2005 Conference Board of Canada: Clouds on the Horizon? “Canada Performance & Potential 2005” Series of international comparative Economic Indicators:  2003 – Canada 3rd  2004 – Canada 6th  2005 – Canada 12th out of 12 countries Oil Prices – 2005 (approximate) 80 70 60 $49.36 50 40 30 20 10 0 04N ov 04Dec 05Jan 05Feb 05Mar 05Apr 05May 05- 05-Jul MidJun Aug 05 Late Aug 05 05Sep 05Oct $49.44 $51.60 $48.83 $54.85 $51.20 $70.85 $59.30 $65.45 $58.09 $64.90 $63.40 $53.32 Price of oil has risen approx. 42% since Jan 1/05 PEST - Social Percent of Population Receiving Social Assistance 1993 Canada Newfoundland & Labrador Prince Edward Island Nova Scotia New Brunswick Québec Ontario Manitoba Alberta British Columbia 10.4 5.5 2003 11.7 9.6 10.7 10.4 10.4 12.1 7.9 7.4 9.2 9.9 5.1 6.2 6.6 7.3 5.5 5.2 1.8 5.5 Source: Roy F. Social Assistance by Province, 1993-2003 Canadian Economic Observers Statistics Canada Nov 2004 Average age of mothers and total fertility rate - 2003 Ave. age in years All mothers 1st time mothers Total Fertility 28.0 26.9 26.6 27.4 26.6 27.7 28.7 26.3 25.3 27.3 28.8 26.7 26.2 21.7 1.53 1.3 1.6 1.4 1.4 1.5 1.5 1.8 1.9 1.7 1.4 1.5 2.0 3.1 Canada NL PE NS NB QC ON MB SK AB BC YT NWT NT 29.6 28.6 28.6 29.1 28.3 29.2 30.3 28.2 27.6 29.0 30.2 28.7 28.1 25.3 Source: Statistics Canada. Births. The Daily July 12, 2005 National Early Learning & Child Care System (QUAD) Principles Quality Universality Accessibility Developmental Focus Post-Retirement Employment • One-fifth (22%) of people who retired between 1992 & 2002 at 50 or older went back to paid work; 4% said they looked for work but couldn’t find any  Reasons for returning:     38% cited financial reasons 22% did not like retirement 19% mentioned “intrinsic” rewards of work 14% wanted to help/felt they were needed Source: Statistics Canada. Study: Post-retirement employment. The Daily September 23, 2005 PEST - Technology Various Polls - IT & Medicine Would you be interested in communicating with your doctor using e-mail/Internet, for example: (% saying yes)  Arrange appointments  Get info. your health condition  Discuss your treatment 67% 63% 52% (source: Berger Health Monitor, March 2001) % Using Electronic Patient Appt/Scheduling System in an Office Setting 60 51% 50 40 30 20 10 0 NL PEI NS NB QC ON MB SK AB BC CAN 18% 16% 30% 25% 27% 40% 40% 29% 38% 13% Source: National Physician Survey November 2004 % Using Electronic Patient Records in an Office Setting 35 30 25 20 15 10 5 0 NL PEI NS NB QC ON MB SK AB BC CAN 8% 2% 10% 8% 8% 4% 14% 13% 13% 14% 29% Source: National Physician Survey November 2004 % Using Electronic Interface with Lab/Diag Imaging in an Office Setting 35 30 25 20 15 10 5 0 NL PEI NS NB QC ON MB SK AB BC CAN 14% 11% 7% 8% 9% 8% 22% 19% 16% 28% 29% Source: National Physician Survey November 2004 The Genomification of Medicine  Biological Revolution: Medicine from cure to prevention  Nano-medicine  3rd Tier of Health Care?  Who pays? Intergenerational Tension? Robot-Assisted Rounds??  Doctors using machines to make rounds, monitor intensive care units, respond to emergency calls, consult other physicians  Pros: allows MDs to use time more efficiently, serve more patients at odd hours & in remote places  Cons: fear technology is further depersonalizing health care, MDs spending less time with patients, eroding what’s left of doctor-physician relationship Source: Stein R. Video robots redefine ‘TV doctor. Washington Post July 6, 2005 HEALTH POLICY ISSUES 1.Supply/ Capacity 2.Demand/ Disease 1. SUPPLY/CAPACITY ISSUES    Health Expenditures System Capacity & Wait Times Physician Workforce - NPS Total Health Expenditures by Use of Funds Canada, 2004 (Forecast) - Current Dollars Percent Distribution of $130.3 billion Other Health Spending 8.6% Hospitals 29.9% Public Health & Admin 6.7% Capital 4.5% Drugs 16.7% Other Institutions 9.6% Other Professionals 11.2% Physicians 12.9% Source: CIHI National Health Expenditure Trends 1975-2004 December 2004 Total Health Expenditures by Use of Funds Canada, 1994 - 2004 - Current Dollars Hospitals-Physicians-Drugs: Percent Distribution 40 35 30 25 35.8 34.4 33.7 32.8 32.3 31.4 31.2 30.3 30.1 29.9 29.9 % 20 15 10 5 0 14.7 12.9 14.4 13.6 14.4 13.9 14.6 14.2 15 14 15 13.6 15.4 13.3 15.7 13.1 16.1 16.3 16.7 12.9 13.2 13 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003(F) Hospitals Physicians Drugs Source: CIHI National Health Expenditure Trends 1975-2004 December 2004 2004(F) Top 5 Therapeutic Classes in Canada - 2004 Therapeutic Class Total (000) % Change over 2003 1. Cardiovasculars 2. Psychotherapeutics 57,703 45,350 7.7 6.6 3. Hormones 4. Anti-infectives 5. Anti-spasmodic /Anti-secretory 24,423 23,423 19,907 -3.9 -3.4 8.8 Source: IMS Health Retail prescriptions grow 5.6% in 2004, down from 7.9% in 2003 Media Release Mar 7/05 Average Prescription Drug Spending (per household) - 2002 450 Household spending on prescription drugs jumped 71% (in 2002 dollars) between 1992 and 2002 403 354 257 415 370 321 335 299 345 318 400 350 300 250 200 150 100 50 0 $ ec a Sa ska tch ew an Pr o vin ces On tar io BC ta Urb an Ru ral Ma nito b Source: Luffman J. Out-of-pocket spending on prescription drugs. Perspectives. Statistics Canada September 2005 Atl ant ic Qu eb Ca nad Alb er a Wait Times & Public-Private Interface Issues Health System Capacity • Canada has the highest acute care occupancy rate (87%) among G-7 countries; ranks 2nd highest out of 21 OECD countries • Canada has 25% fewer acute care beds per 1000 population than the OECD average (ranks 13th of 25) • Canada has 25% fewer physicians per 1000 population than the OECD average (23rd of 29) Source: ACAHO. Presentation to the House of Commons Standing Committee on Finance October 6, 2005 FEDERAL-PROVINCIAL COMMITMENT TO WAIT TIME BENCHMARKS  December 31/05 deadline for establishing benchmarks  WTA benchmarks established  Commitment/agreement not likely  Delay tactics – waiting for CIHR evidence  Dysfunctional federal/provincial/territorial relationship a key factor  Physician inspired solutions – high public acceptance & low political traction Canadians and the Chaoulli Decision On the one hand… But on the other… 64% believe the decision means two- 70% feel they should be able to buy tiered health private services if they want care in Canada 57% think their province should use the notwithstanding clause to ban private insurance 50% agree the decision will mean American style health care (47% disagree) 60% think the ruling will lead to shorter wait lists in their province 54% think the ruling will mean service improvements Source: Ipsos Reid Canadians react to Supreme Court healthcare ruling. Media Release June 18, 2005 Public/Private Funding of Health Care % Total Health Care Funding – Public United Kingdom Germany 83% 78% France Canada 76% 70% United States 45% Source: CIHI Exploring the 70/30 split: How Canada’s Health Care System is Financed September ,2005 The HHR Perfect Storm  Aging of population - >80 years group to grow by another 43% by 2011  Greying of the workforce - median age of core age group = 41.3 years (up 3.2 years over last decade)  Median age of physician workforce even older  Sub-optimal physician supply policies  “Get-a-Life Generation” in medicine  Medical malaise  Age of chronicity Access to Professional Programs Amid Deregulation of Tuition Fees • Between academic years 1995/96 to 2001/02 tuition fees in Canada rose 80% in law, 160% in medicine and tripled in dentistry • Largely driven by fees in deregulated professional programs in Ontario in 1998: medicine – fees quadrupled; dentistry – fees rose five-fold; law – tripled • Over same period: BC – fees in medicine & dentistry fell 3% & 5% in law; Québec – fees were stable in law but rose 44% in medicine & 27% in dentistry. Both provinces maintained regulated fees • Deregulation or deregulation experiments tried in NS, MB, SK & AB - resulted in increases between the extremes of Ontario & BC/QC Source: Statistics Canada. Study: Access to professional programs amid the deregulation of tuition fees. The Daily September 27, 2005 MinuteClinic: “You’re sick. We’re Quick” •Opened in Indianapolis, others planned in a dozen more sites •Designed to treat common ailments in 15 minutes with no appointment •Staffed by a nurse practitioner “trained to diagnose & treat common ailments & provide basic services such as vaccinations” •No doctor on site; concerns about it being “convenience over care” •“Fast food for illness”, what “ATMs brought to banking” Source: Associated Press. Quick diagnosis clinics to open in Ind. Washington Post September 26, 2005 “Nighthawk” Radiology A shortage of trained radiologists in the US has doctors on overnight shifts in hospitals sending MRI, CAT & x-ray scans to facilities in other states and countries to be read. Concerns have been raised over quality, diminished care & potential privacy violations Source: Mishra R. Radiology work shifts to overnight, overseas. Boston Globe June 29, 2005 2. DEMAND/DISEASE SIDE ISSUES      Chronic illnesses, obesity The aging bulge in the population The unhealthy youth behind it Maternal and child mortality Infectious disease/pandemic HEALTH POLICY - DEMAND Obesity & Diabetes “Diabesity” The Chronic Illness Triple Threat Obesity Physical Inactivity Type II Diabetes DEMAND-SIDE THREATS: OBESITY Obesity Rate More Than Doubled For Some Age Groups in Canada 30 25 20 15 10 5 0 12-17 yrs 25-34 yrs 75+ 3 9 9 11 1978/79 2004 24 21 Source: Statistics Canada. Canadian Community Health Survey: Obesity among children & adults. The Daily July 6/05 % Canada’s Obese Youth  In 2004, 26% of Canadian children and adolescents aged 217 were overweight or obese; 8% were obese  For adolescents ages 12-17 the increase in the overweight/obesity rate more than doubled and the obesity rate tripled  The overweight/obese rate for boys aged 12-17 in 2004 was 32.3%; the obesity rate was 11.1%  The overweight/obese rate for girls aged 12-17 in 2004 was 25.8%; the obesity rate was 7.4% Source: Tjepkema M., Shields M. Measured Obesity: Overweight Canadian children and adolescents Nutrition: Findings from the Canadian Community Health Survey Issue No. 1 Statistics Canada July 2005 YOUTH, OBESITY & LONGEVITY: New England Journal of Medicine  “If nothing changes for the better today’s younger generations will live shorter lives than their parents”  Over the next 40 years longevity may decrease by 3 to 5 years due to obesity  Relative magnitude: cancer currently reduces longevity by 3.5 years Source: Tjepkema M., Shields M. Measured Obesity: Overweight Canadian children and adolescents Nutrition: Findings from the Canadian Community Health Survey Issue No. 1 Statistics Canada July 2005 Hip/Knee Replacements in Canada Total hip/knee replacement patients by BMI Category, Fiscal 2003 60 50 40 37 26 12 2 Hip Replacements Underweight Acceptable 1 Knee Replacements Overweight Obese 35 33 54 % 30 20 10 0 Source: Canadian Joint Replacement Registry. 2005 Report Total Hip and Total Knee Replacements in Canada. CIHI August 2005 Diabetes in Canada Evaluation – DICE Observations & Findings  Current practices are not aggressive enough to manage a substantial proportion of type 2 diabetes patients  The DICE study shows that one in two Canadians with type 2 diabetes does not have their blood sugar under control. Control is worse the longer the patients have diabetes.  Getting to target levels faster reduces incidence of downstream complications.  Gap between knowledge & practice. Source: Canadian Diabetes Association. Canadian diabetes study: A Wake-up Call. Media Release September 20, 2005 Projected deaths by cause, all ages – Canada, 2005 Communicable, maternal & perinatal, nutritional deficiencies 5% Other chronic diseases 17% Diabetes 3% Injuries 6% Chronic repiratory disease 6% Cardiovascular disease 34% Cancer 29% Source: WHO. Preventing Chronic Disease: a vital investment. October 2005 The Age of Chronicity  53% of Canadians reported being diagnosed with at least 1 chronic illness  13% of Canadians reported being diagnosed with 2 chronic illnesses  15% of Canadians reported being diagnosed with 3 or more chronic illnesses  86% of Canadians in poor or fair health reported having a chronic illness  Increased age, female gender, unemployment, lower educational status, lower income associated with reporting chronic illness Source: Health Insider, Survey no. 11, 2004, IBM Consulting Services Economic Impact:  Canada will lose $500 million in national income from premature deaths due to heart disease, stroke and diabetes in 2005  Canada stands to lose $9 billion over the next ten years Source: WHO. Preventing Chronic Disease: a vital investment. October 2005 Economic Burden of Illness in Canada Total Costs: Top 5 Diagnostic Categories  Cardiovascular Diseases  Musculoskeletal Diseases $18.5 B $16.4 B  Cancer  Injuries $14.2 B $12.7 B  Respiratory Diseases  Total $ 8.5 B $70.3 B Economic Burden of Illness in Canada Direct Costs: Top 5 Diagnostic Categories  Cardiovascular Diseases  Mental Disorders $4.7 B $6.8 B  Digestive Diseases  Respiratory Diseases $3.6 B $3.5 B  Injuries  Total $3.2 B $21.8 B Economic Burden of Illness in Canada Indirect Costs: Top 5 Diagnostic Categories  Musculoskeletal Diseases  Cancer  Cardiovascular Diseases  Injuries $13.7 B $11.8 B $11.7 B $ 9.5 B  Nervous System  Total $ 5.5 B $ 52.2 B HEALTH POLICY - DEMAND: Infant/Maternal Health Infant Mortality Deaths per 1000 live births – OECD, 2003 1. Iceland 2. Japan 2.4 3 6. Czech Rep. 6. France 3.9 3.9 3. Finland 3. Sweden 3.1 3.1 8. Spain 8. Portugal 4.1 4.1 5. Norway 3.4 22. Canada 10. Germany 4.2 5.4 Source: OECD Health Data 2005 June/05 Perinatal Mortality Rate – OECD 2002 1. Iceland 2.7 2. Japan 3. Australia 3.7 4.2 4. Czech Rep. 5. Italy 4.5 4.8 11. Canada Source: OECD Health Data 2005 June/05 6.3 Maternal Mortality Rate – OECD 2002 1. Iceland 2. Greece 3. Germany 4. Czech Rep. 5. Spain 0 1 2.9 3.2 3.3 9. Canada 4.6 Number of maternal deaths, all causes, per 100 000 live births Source: OECD Health Data 2005 June/05 HEALTH POLICY - DEMAND Avian Influenza Influenza Pandemic  Public Health Agency predicts 11,000 – 58,000 deaths if no vaccine available  34,000 – 138,000 hospitalizations  Two to five million outpatients  Estimated health care costs: in the range of $1.4 billion  Estimated societal costs: $5 billion to $38 billion  Expectation is that is it will be some form of H5N1 Human Avian influenza A (H5N1) Country Total Cases* Deaths Indonesia Cambodia Thailand Vietnam *Since December 2003 5 4 17 91 3 4 12 41 Source: World Health Organization October 2005 Infectious Diseases – H5N1  First signs avian influenza has spread into Europe and North America from migratory birds  No confirmation of the exact strains Sources: Associated Press. Turkey orders fowl destroyed in bird flu scare. Ottawa Citizen October 9, 2005; Nickerson C. Europe bracing to battle bird flu. Boston Globe October 10, 2005 CLOSING PERSPECTIVES  Infant, peri-natal, child & maternal mortality rates.  Maxed-out health care system  Dysfunctional or broken federal/provincial health care relationships at most senior level (who’s in charge of the care of the health of Canadians?)  Economic performance – 3rd to 6th to 12th