Rural Healthcare: Are Two Aspirins Enough

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Rural Healthcare Are Two Aspirins
Enough?
Presentation to ROMA/Good Roads
Conference February 20, 2006 Roy Ingram -
Councillor Quinte West - Director ROMA
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The rural healthcare dilemma

• Difficult problem
• No easy answers
• Each situation is unique
• Many variables to consider
• Involves province and municipalities

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Canadian Institute for Health Information
Report Rural Doctors

• Rural areas or small towns have
• 9 of physicians
• 20 of population lives in these areas
• 16 family doctors
• 2 specialists

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Canadian Institute for Health Information
Report Rural Doctors

• Rural areas or small towns have
• 1 of pediatricians
• 3 of obstetricians and gynecologists
• 2 emergency medicine specialists
• 3 of psychiatrists

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Canadian Institute for Health Information
Report Rural Doctors

• If rural family doctors didnt provide some
  specialty services, many people would be forced
  to travel even greater distances to get medical
  care or they would simply go without.

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Hospital Annual Planning Submission (HAPS)

• Transition to multi-year business planning
  process
• Identify and implement operational efficiencies
• 7-step process

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HAPS The 7-Steps

• Step 1 Revenue generation
• Step 2 Efficiencies in administration and
  support services
• Step 3 Efficiencies in diagnostic, imaging,
  pharmacy, laboratory and ancillary services

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HAPS The 7 Steps (Contd.)

• Step 4 Clinical services program
  efficiencies
• Step 5 Utilization management
• Step 6 Clinical services program
  consolidation
• Step 7 Reduction of clinical services

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Quinte Healthcare an example

• Amalgamated in 1997
• Multi-site hospital - four locations
• Catchment area - 7000 square kilometres
• Finances - two hospitals in black
• All full-service hospitals

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Problems at Quinte Healthcare

• Poor communication with stakeholders
• Lack of openness with doctors, nurses,
  municipalities and other stakeholders
• Closed door meetings

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HAPS and MisHAPS

• HAPS Steps 1-5 handled with little controversy
• Step 6 no consultation with stakeholders on
  reduction of clinical services
• Public outcry at lack of consultation or
  communication

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HAPS and MisHAPS (contd.)

• Local mayors, doctors and MPPs question Boards
  decisions
• Board refuses to submit a balanced budget to the
  Ministry of Health
• Asks province for an additional 6.8 million with
  no breakdown on how additional money is to be
  spent

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HAPS - Step 6 Missteps

• Surgeon quits - blames instability of QHC
• Lab work privatized and consolidated
• Doctors submit letters of protest
• Angry public attend rallies, sign petitions

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Ministry Response

• Ministry of Health sends provincial reviewer to
  look at QHC governance report to follow
• Joint Policy Planning Committee to examine
  hospital services report due late March

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Areas of Concern for Rural Healthcare

• Perceived urban agenda
• Unique geographical locations
• One size fits all solutions
• Ongoing costs pressures
• Scarcity of doctors, nurses, etc.
• Infrastructure needs

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PerHAPS Some Needed Definitions

• Policies specific to rural healthcare
• Standards for quality care in rural areas
• Levels of service and access to them
• Appropriate distances/travel time
• 24/7 emergency care

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LHINs The vision

• Our vision is of a system where all providers
  speak to one another in the same language, where
  there are no longer impenetrable and artificial
  walls between stakeholders and services - a
  system driven by the needs of patients not
  providers
• Minister of Health George Smitherman

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LHINs The Solution?

• Not a single hospital is going to be closed on
  my watch. Period.
• Minister of Health George Smitherman
• (Bill 36) could lead to the effective closing of
  hospitals if acute care is consolidated in a few
  major facilities within each LHIN and the rest
  are turned into ambulatory care centres.
• Ian Urquhart, Toronto Star

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LHINs - The Promise

• To create a truly integrated and seamless system
  of care that works for the patient
• To establish and meet the healthcare needs of the
  community
• To streamline patient care through integrated
  information and healthcare delivery services
• To coordinate, plan and fund health services by
  engaging stakeholders at the local community level

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• Roy Ingram
• Councillor Quinte West
• Director ROMA
• email roy4sidney_at_reach.net