Can We Save Medicare?

Murray MacKenzie President and CEO, North York General Hospital and Chair-Elect, Ontario Hospital Association CAN WE SAVE MEDICARE? Chairman: Robert J. Dechert President, The Empire Club of Canada

Head Table Guests

Willis L. Blair, Vice-President, Toronto East General Hospital Foundation and a Director, The Empire Club of Canada; Dr. Diane Bridges, D.M., J.P., Director of Pastoral Care, Peel Memorial Hospital; Natashya Lallani, Grade 11 Student, Georges Vanier Secondary School and Member of Partnership Committee, Georges Vanier/North York General Hospital; Brian Birkness, Senior Partner, Deloitte & Touche and Past Chairman, Ontario Hospital Foundation; David Shaw, Chairman, Stand by Me Campaign for North York General Hospital and Former President, Pepsi Canada; The Hon. Thomas L. Wells, Former Minster of Health, Province of Ontario, President, TLW Consulting and a Director, The Empire Club of Canada; Dr. Reuben Devlin, President and CEO, Humber Regional Health Sciences Centre and President, Ontario PC Association; Karon Bales, Partner, Gowling Strathy & Henderson and Chairman of the Board, North York General Hospital; and Brian Steck, ViceChairman, Bank of Montreal and Chairman of the Board, North York General Hospital.

Introduction by Robert J. Dechert

Canadians are justifiably proud of their health-care system-a system that was designed in an era of demographically low healthcare demand, big government and deficit financing.

Thirty years later, our health-care system is struggling with an explosion in demand for health-care services by an aging post-war baby boom generation, new and increasing technology costs, fiscally prudent governments and overburdened taxpayers crying out for relief. How do you run a hospital and a health-care system in today's environment?

Our guest speaker is well qualified to answer these questions. Mr. MacKenzie obtained a Master's degree in Health Administration from the University of Toronto. From 1974 to 1989, he served in various senior management positions with Mt. Sinai Hospital in Toronto.

In 1989, Mr. MacKenzie joined the North York General Hospital as President and Chief Executive Officer.

Over the past 20 years, Mr. MacKenzie has served in many senior positions with the Canadian Cancer Society. As President of the Ontario Division, he is currently a board member, executive committee member and Chairman of the Audit, Finance and Human Resources Committee of Cancer Care Ontario.

He is also the current "Chair Elect" of the Ontario Hospital Association.

Mr. MacKenzie was a recent recipient of the "President's Achievement Award" of the Society of Graduates in Health Administration of the University of Toronto.

And just last year Mr. MacKenzie was honoured as CEO of the Year by the North York Chamber of Commerce.

Ladies and gentlemen, please help me in welcoming Mr. Murray MacKenzie to the podium of The Empire Club of Canada.

Murray MacKenzie

Good afternoon. It's a great pleasure to be with you today and I want to thank you all for the warm reception. You've made me feel at home and for that I am grateful. I hope I can return your kindness by shedding light on what has been a divisive and difficult issue, that touches the lives of each and every one of us.

I'm talking about Medicare. In many ways, it is part of what makes us Canadian.

Public opinion surveys tell us that Canadians endorse Medicare although their satisfaction with the health system seems to be waning. Surveys also tell us that many Canadians are afraid Medicare may not be there for them in the years ahead.

I am here to tell you that, as it stands now, the prognosis for Medicare is grim-unless we make some major changes to how we organise and deliver health services. Let me bring this closer to home. It pains me, this day, to tell you that health care in Ontario faces grave risk and, unless we act, our ability to continue to deliver quality patient care services is under serious threat.

In fact, it is no secret that hospitals are under considerable financial pressure and many are operating with deficits. The collective debt of Ontario hospitals is $2.2 billion and that debt is rising every day.

We have improved the overall efficiency of the hospital system. But we are now at the point where there is so little flexibility in the system that hospitals are hard pressed to meet community. needs. And, it appears that we will be asked to get by with even less funding this year around $300 million less. That is why the hospitals of Ontario, through the OHA, have joined the premiers in asking the federal government to fully restore federal transfers to provinces. Otherwise, there will be less funding available to address patient-care needs right across the province.

For example, some hospitals across Ontario are paying their employees on credit. Their suppliers are being forced to wait months to get paid. They can't afford to upgrade and replace equipment except in emergency breakdown situations.

You may be surprised to learn that Canada is way behind on the medical high-tech front. Canada is ranked in the bottom third among OECD countries when it comes to the availability of medical technology, like CT scanners, magnetic resonance imaging machines and lithotripters.

All can help to save lives and alleviate suffering, but we can't afford them.

And there is demographic pressure ahead. Right now, the number of Ontario residents over age 65 is just over one-in-eight. In 25 short years, that number will balloon to one-in-four, as the baby boomers head toward retirement.

With this "graying" of Ontario, the costs of acute care, long-term care, rehabilitation, primary care and home care will skyrocket. The government's share of these costs will rise from about one-third of the provincial budget today to almost half. The current cost of health care-about $2,700 per person, per year-could soon rise to around $3,500 per person in constant dollars in less than a generation.

But that would be a picture painted with the status quo. As incoming chairman of the Ontario Hospital Association, I want to make it very clear that the status quo is not acceptable. We can make it better.

Will more money help? Yes. But that is not the only answer and certainly no panacea. What else should we be doing? For starters, we need to:

- Fundamentally reorganise our health system;

- Engage in meaningful dialogue with the public about realistic expectations;

- Develop a reliable long-term staffing plan for doctors and nurses; and

- Implement new systems of accountability and funding based on quality and outcomes.

And we need to make these changes across all sectors, not only in hospitals.

Today I want to focus on the need to embrace a fundamental reorganisation of our health system. And one of the driving forces that can transform health-care "crisis" to health-care "success," is connectivity or integration. What do I mean by "integration" in health care? Perhaps the best way to explain it is to tell you about some of the efforts toward integration at North York General.

We are the only hospital located in north-central Toronto north of Lawrence Avenue. With fewer dollars and more responsibility throughout the late 80s and 90s, it was clear things had to change. "Tinkering" was not enough. We needed to fundamentally rethink how we delivered care.

We developed a bold new vision: to be a leader in shaping health care for tomorrow. The core of this vision is to become an integrated health system. Integration is beginning to work for North York General, and I suggest to you it can work right across Ontario.

Integration ensures patients receive the right care, at the right time, at the right place, and by the right provider. To better understand Integration, let's look at the wide range of services provided by our health-care system today.

When most people think about health care, they think about hospitals with their nurses and doctors. Well hospitals are only one part of the health-care system. There is also long-term care, home care, rehabilitation and primary care. And they are all inter-related. They are not islands unto themselves. Integration helps link it all together. It creates an organisational framework to bring these and other services together to better serve patients, families and the system.

And what is the essence of effective integration? Teamwork. At the core of an integrated health system, you will find primary care teams. At North York General, we're planning to have about two dozen of these teams throughout our service area.

Each team will serve between 12,000 and 25,000 members of the community. These multi-disciplinary teams will consist of family physicians, nurse practitioners, social workers, dietitians, physiotherapists, occupational therapists and pharmacists. These teams will be the patient's principal link to the health-care system. You could say they are the "compass" that will help patients "navigate" the full continuum of health care.

I'm sure you will agree that all of this sounds great. But how will integration make a real difference in the lives of patients? Let me give you some concrete examples.

It means you'll be able to call one telephone number to speak to a caregiver who is familiar to you. And someone will be at the other end of the phone after hours and on weekends. It means you'll have one electronic patient record. You won't have to repeat basic information when you visit different professionals. Your test results and medication records will be in one file so all the information is right there.

We are not there yet, but we are steadily working toward this vision, and have made many inroads. Here are some practical examples of how integration is benefiting our patients today.

Successful integration is based on partnerships. We have built a partnership with the North York Community Care Access Centres where we account for 70 to 80 per cent of their referrals for home care. We transfer patients to St. John's Rehabilitation Hospital within days of hip and knee replacement surgery, so they can begin intensive therapy as soon as possible.

Over 20 years ago, we recognised that an acute care hospital is not the place to care for our elderly waiting for long-term care. So, we opened the Seniors' Health Centre. It's a 160-bed nursing home that provides care for people who can no longer live independently in the community.

What's important in this scenario are the linkages between the two-acute-care and long-term care. The specialised resources of the hospital are readily available to the residents of the nursing home. Specialists still do consultations-but they visit the Seniors' Health Centre. And whenever possible treatment is provided there.

Staying with the theme of seniors, we are very excited about a new initiative called the Geriatric Services Line. We know that the health system is complicated and can be confusing, especially for seniors and their families. The Geriatric Services Line is a one-stop shopping concept. By calling one number, caregivers, family members-even physicians-can access all the geriatric services offered at our three sites.

We take the mystery out of the process. We assess the need and then refer to the most appropriate servicewhether it's a specialised clinic, a Day Hospital rehabilitation programme, an inpatient assessment unit, or an in-home assessment.

With one service, with one telephone number, we'fiave bridged several different sectors-hospital, community, rehabilitation and long-term care-to create a solution that is totally client-focused. And it's as simple as a telephone call. And we know it's helping. Since launching the service last December, we have logged over 10,000 calls.

Yet another example of teamwork is our new in-home palliative care service. Seventeen family physicians are committed to providing in-home patient care. In addition to making home visits, this palliative care programme is unique because the family physician takes care of the terminally ill patient at home and in the hospital, thereby ensuring continuity of care through this difficult period.

And finally, let me tell you about another partnership that successfully bridges the hospital and community sectors. It's called the First Days programme. It was developed several years ago in response to concerns that health professionals and the public had about shorter hospital stays after having a baby. North York General contracted with St. Elizabeth Health Care, a community nursing agency. St. Elizabeth nurses conduct home visits to new mothers and babies who leave the hospital after 24 hours. Our research shows an encouraging 90-per-cent satisfaction rate with this programme.

While all this is breaking new ground in Ontario, there are other jurisdictions in Canada and around the world that are moving aggressively on this front. Why aren't we? In all honesty, this vision of health care cannot be fully realised until we break down the barriers to integration that permeate our health-care system today.

The Ontario Hospital Association has identified no fewer than eight major barriers to this integrated health system in Ontario. Barriers that include lack of consensus, inconsistent funding arrangements, and a lack of integrated information systems, to name only three.

The most critical of these barriers is the resistance to change. Many within health care today simply don't want to give up power and control. They must realise that the key to success is teamwork, and the key to teamwork is co-operation. Working together, everyone wins.

Ladies and gentlemen, this is a wake-up call. A call not only to those within the health field but also to community leaders and concerned citizens right across Ontario. It is a wake-up call for government, because in the end it is up to our elected officials to join our team and help remove the roadblocks. If the major barriers are removed, I believe that leaders in all sectors will find ways to create the most effective mechanisms of integration in their communities.

We must all work together to ensure that Medicare adapts to these new and emerging realities. It is time to stop using band-aids to correct problems that require system therapy. We can no longer move from one three-month crisis to the next.

The future of Medicare is in all of our hands. Teamwork is what can make the difference. Because, when all is said and done, we are all in this together.

Thank you.

The appreciation of the meeting was expressed by The Hon. Thomas L. Wells, Former Minster of Health, Province of Ontario, President, TLW Consulting and a Director, The Empire Club of Canada.