Medicinal services, Community Health and Governance

Presentation Transcript

Human services, Community Health and Governance Dr. David Zitner , Director Medical Informatics Ryan Sommers , Department of Community Health & Epidemiology Janet Rigby , Department of Community Health and Epidemiology Dalhousie University Partly bolstered by Health Cares Hidden Face An AIMS/Max Bell Foundation Project. May eighth, 2002 - CES Conference 2002

ORGANIZATIONAL STRUCTURE INFLUENCES HEALTH CARE AND EVALUATION Current condition outline Provincial/National (Zitner) What occurs in genuine (Sommers) Governance model and solutions(Rigby) including unbundling the capacities protection, administration & administrator, assessment

Monopoly Health Care Unknown Quality Dr. David Zitner , Director of Medical Informatics Dalhousie University

CURRENT CIRCUMSTANCE Public not happy with administration 56% feel wellbeing framework is fumbled 90+% accept astounding consideration is gotten from clinicians Most trust administrator. changes exacerbate mind worse general society is benevolent, we are missing indispensable data for administration - get to & comes about.

PUBLIC HEALTH:STATE SECRET UNREGULATED MONOPOLY LACK OF INFORMATION TO MANAGE SEPARATE INSURANCE, ADMINISTRATION AND GOVERNANCE, REGULATION, AND EVALUATION. Fortify ROLE AS REGULATOR

PUBLIC/PRIVATE SECTORS REVENUE MUST BE GREATER THAN EXPENSES CANADIAN HEALTH CARE Underservicing as a strategy to cut costs Same as feedback of U.S. HMO's Proximity of care Menu of administrations Waiting circumstances

CANADA HEALTH ACT Access (over the top holding up times) Portability( distinctive menu of administrations) Comprehensiveness (drugs, physio, menu not known) Universality (WCB. All around associated, Armed powers have favored get to and Occupational Health Circumstance PUBLIC ADMINISTRTATION-Enforced

ACCOUNTABILITY "Open arrival of execution information is regular in the unified states. There are a wide range of sorts of reports distributed by medicinal services suppliers and governments; national magazines distribute data about the "best" Hospitals, medical coverage arrangements and doctors; internet destinations permit individuals to look at doctors, clinics and arrangements" For an assortment of reasons there is generally minimal similar authoritative execution information accessible to the general population in Canada. This might be a direct result of the single-payer framework, and of a more broad social distinction towards open responsibility. (What does general society need to know:Murray,M., Kline, D Hospital Quarterlyvolume two • number two • Winter 1998-1999)

Operating in the Dark, Over and Over once more! Who holds up?? To what extent?? Who Gets Better? More awful? Who is destined to have poor results? Mistake Detection??? Contrast and www.phc4.org

ACCESS/WAITING TIMES COMFORT SEVERITY FUNCTION PUBLIC WANTS INFORMATION ABOUT RESULTS OF CARE-CHANGES IN - COMFORT, FUNCTION, LIKLIHOOD OF DEATH . Hold up TIME, FATE OF WAITING PATIENTS

DATA GATHERING CIHI $95,000,000 x 2 = $190,000,000 Discharge Abstract Data Base (DAD) Provinces significantly more $$ to populate DAD $1,500,000 for a 400-500 bed clinic LENGTH OF STAY BY DIAGNOSIS CIHI Data may not be precise as per CIHI cautioning and specialized notes despite the fact that its utilized for administration and studies

AUDITOR GENERAL "...In connection to the Canada Health Act, I watched that Health Canada does not have the data it needs to successfully screen and give an account of consistence. So,within those regions of government duty obviously better quality data is required..." (Dennis Desautels, Jan. 2000 reaction to OID)

What do we think about execution of open/private Governments spend intensely on data however don't connect exercises and comes about or have routine measures of holding up time No confirmation that open arrangement has better general results or that individuals rank Canadian framework as better than different frameworks ( Blendon, R.J., Kim, M., Benson, J.M., The Public Versus the World Health Organization on Health System Performance, Health Affairs, Chevy Chase; May/Jun 2001; Vol. 20,3; pg. 10-21)

USA COMPARISON USA 15% OF HOSPITALS, 12% OF BEDS ARE FOR PROFIT. REMAINING ARE NOT FOR PROFIT Neonatal results Very low birth weight babies require escalated therapeutic treatment.

INFANT MORTALITY 886/1000 13.5 2000-2499 13.8

WHAT INFORMATION IS AVAILABLE? QUALITY? We need essential data to empower governments to satisfy the suitable administrative part Normally governments manage restraining infrastructures. For this situation government is the monopolist!

DATA QUALITY FALSE ALARMS Length of remain by conclusion and investigation CIHI - the information may be mistaken CONTEXT INEFFICIENCY INCREASED LOS on account of absence of group assets which are the duty of same gathering as the gathering shutting healing centers.

DM COMMITTMENT 1994 "WHEN LESS IS BETTER" Timely get to must be ensured and data about holding up times made open That nature of care will be guaranteed by progressing observing and production of results as changes are actualized

Bill 34-CONFLICT OF INTEREST? "To oversee, arrange, oversee, screen, assess and convey wellbeing administrations in a wellbeing locale" 'The priest decides the administrations gave in an area" Other purposes stay away from duplication of administrations address issues of wellbeing district(all needs? Whose? Will individuals move to locale which bolster their specific medical issue?

"To keep up and enhance the wellbeing of the occupants" But different administrations, sanitation, monetary advancement, training, condition are gone for keeping up group wellbeing! Is this a duplication? Recognize ailment care and group advancement Health sheets could screen group wellbeing to give data on adequacy of different projects (E.G. Number of smokers reflects instruction) and give adequacy report. Need to cover profit of administrations gave.

CONFLICTS OF INTEREST Payment, administration and assessment are altogether represented by a similar structure Consider free administration for installment and assessment isolate from organization Regulated imposing business models would not be permitted to support a portion of the states of mind and results which exist in today's system(waits,quality)

GOVERNANCE "Purposing Function" Purpose of Administration in Health Care Improve wellbeing Link exercises and results with a specific end goal to dodge unnecessary or unsafe exercises Efficient organization Efficiency=cost/advantage Benefit in human services is enhanced wellbeing where measurements are solace, capacity and survival Appropriate get to

Existing framework (multi level) Armed strengths, Workers Compensation patients have distinctive levels of care and get to Excessive holding up times Public needs trust in medicinal services administration Unreliability of existing Canadian information beds, assets, results

SEPARATE FUNCTIONS Shouldice doctor's facility, is a private association which contracts to give a particular arrangement of administrations. Arrangements: Most proficient supplier give benefit whether in broad daylight or private area Need unequivocal execution ensures about quality (results and holding up time).

RECOMMENDATIONS Distinguish between protection framework, benefit conveyance and assessment segments Implement fitting data frameworks what number of individuals show signs of improvement? more regrettable? Who holds up? To what extent? Group Context? Who has poor outcomes and reasons Implement reconnaissance frameworks not ventures. Today Heart illness is very much concentrated however no general data frameworks exist Implement constant hold up rundown frameworks Implement appropriate provoking frameworks to bolster clinical care, wellbeing administrations organization, look into, instructing

Evaluating our Communities' Health: Experiences from a Community Health Board Chair Ryan Sommers, BSc., Masters Candidate Department of Community Health & Epidemiology Dalhousie University

Presentation Overview My Experiences What is a Community Health Board (CHB)? What does a group wellbeing board do? Assessing the Health of the Community and Citizen Involvement Our way to deal with assessment Challenges/Issues Conclusions

Introduction - My Experiences Graduate Student - Department of Community Health & Epidemiology, Dalhousie University Volunteer Co-seat, Cobequid Community Health Board Largest CHB in NS, 1/4 the extent of Capital Health District Authority, Bedford, Sackville and Surrounding Areas, 90 000 individuals Also co-seat the Capital Health Council of Chairs (Group that speaks to every one of the 7 CHB in the Hfx and encompassing ranges)

Introduction Citizen association and wellbeing change Not really another wonder Historically, Canadians have been extremely dynamic in the medicinal services framework Part of social insurance regionalization Most purviews include natives as a major aspect of a board that is in charge of the administration and organization of wellbeing administrations at the provincial and nearby level

Citizen Participation Reasons for resident engagement in human services Incorporate individual and group inclinations and qualities into human services choices Improve responsibility and government obligation Strategy to help enhance the strength of groups (enable groups for more prominent confidence) Key segment of essential medicinal services, wellbeing advancement and group (WHO - Primary Care, some portion of Health Promotion and Health for All)

Models of Citizen Engagement Most Cdn wards work under a regionalized structure - with a board comprising of subjects Some territories have two levels of contribution Regional/District level sheets (e.g. Region Health Authorities) Local level counseling bunches (e.g. BC and Alberta: Community Health Councils)

Citizen Engagement Models Most research has fo