Executive Summary
INTRODUCTION
Canada 2020 brought together a diverse group of health practitioners
and health policy experts to look at the future of innovation in health care
and how it will help Canadians seeking care and support their families through
the health care experience. All this was done against a sobering look at the
cost of health care across Canada.
The discussion was not theoretical as it focused on the improvement of
care through innovation and in the case of the Children’s Hospital of Eastern
Ontario the roadblocks to innovation. The Canadian government is attempting
through a new initiative to find ways to change the regulatory culture in
order for it to be sufficiently agile to
keep up with innovation in care so that Canadians are not deprived of new
remedies stranded in regulatory limbo.
The Honourable Mary Ng spoke of the government’s initiative to foster
innovation through the creation of the CAN Health Network.
There was an important discussion about values and innovation and
finally a political gloss was put on the proceedings in the areas of
pharmacare, pandemics and federal-provincial relations regarding health care.
VIRTUAL CARE, Dr. Sandy Buchman, President, Canadian Medical Association
He focused on the need to advance virtual care and its technology as it
is of great assistance to those in remote communities as well as helping
patients receive care where they live. The CMA’s Virtual Care Task Force
mandated to “promote the delivery of publicly insured medical services through
virtual means” has reported.
It recommended that national standards be developed for patient health
information access, simplification of registration and licensing processes so
that qualified physicians can provide virtual care across provincial and
territorial boundaries and update virtual care competencies among medical
students and as part of continuing education for doctors.
As well a pan-Canadian framework establishing excellence in virtual
care must be developed.
Dr. Buchman’s presentation set out a theme that continued throughout the day; regulators and governments need to keep up with innovation and changes in health care delivery or just get out of the way. Medical advancements are too important to be derailed by regulatory inaction and red tape.
HEALTH CARE COSTS, DEMOGRAPHIC PRESSURES AND EMERGING CHALLENGES, Mostafa Askari, Chief Economist, IFSD, Uottawa
Askari presented a chilling report on rising health care costs. He used
the metric of comparing rising health care costs to increases in GDP and the
overall trend is that spending on health care has increased and it is growing
faster than the economy. They are also rising faster than other government
expenditures.
Costs are driven by increases in GDP, an ageing population and growth
in excess costs. On ageing, costs jump considerably for the group between 85-90
years of age. And life expectancy is increasing adding to the pressures on the
system.
While it seems counter intuitive, Askari explained that the use of
advanced technology actually increases costs, adding more pressures. Every
province has seen an increase in health expenditures as a share of GDP and they
face the choice of dealing with these fiscal challenges by either raising taxes
or reducing expenditures.
The present fiscal imbalance between the federal government and the
provinces means the federal government will be asked to increase the health transfers.
Given these challenges, Askari asked whether it is time to review the Canada
Health Care Act to see what can be done to make health care sustainable.
On the subject of pharmacare he doesn’t see how, given the federal fiscal situation, the federal government can do more than fill provincial gaps.
PANEL DISCUSSION: GROWING THE HEALTH INNOVATION ECOSYSTEM, Matthew Collingridge, General Manager, Digital, GE Healthcare, Janet Daglish, National Director, Bayshore and Bill Charnetski, EVP, PointClickCare
Charnetski sees health care innovation as an economic driver and job
and wealth creator fuelled by the adoption of new technology. It should lead to
long term economic growth. But he stressed the need to improve productivity in
the provision of health care as the system is not sustainable as presently constituted.
Daglish spoke about the development and use of a digital health
platform where data is collected to provide better care. A digital experience
is created for patients which they can access and share with family to help in
providing support in hospital and afterwards. This leads to better patient and
family cooperation along the care journey. The patient controls who has access
as the patient is in charge of their health data. We need to create the right
experience for the right patient.
Collingridge talked about GE seeing its role as looking for what we are
missing and what can be done differently particularly using Artificial
Intelligence. This should increase productivity in the health care system. He
set out challenges: need to move more quickly in accessing data; technology
developed must be “true and proven”; competition is needed as well as reinvestment
and the delivery of health care needs to be accelerated. He has three
suggestions: drivers’ licences could provide a note that on death medical
records are to be donated; P3 collaboration should be used to solve specific
problems and the system needs to be more agile in seeking funds, utilizing
means such as crowd funding to address certain issues.
The goal is “the best of care at lowest cost” and this can be done by driving productivity while eliminating errors and inefficiencies.
STEPPING INTO THE FUTURE OF TREATMENT AND CARE IN CANADA, Elizabeth Toller, Ex. Director, Regulatory Innovation, Health Canada and David Lee, Chief Regulatory Officer, Health Canada
This session offered hope that, first, the federal government realizes
that the present regulatory approach is not keeping up with innovation and
probably impeding it and second, there is a commitment to provide more agility
in the regulatory process to help further innovation.
Lee explained it is difficult for regulations to keep up with
innovation given the complexity of new drugs and processes used to develop them
as well as shifts in health treatment. Treasury Board has authorized
expenditures on bringing innovation to the regulatory process.
Toller explained that the focus is now on making regulations more agile
without lessening the commitment to safety. This is to be accomplished through:
clinical trials which could include virtual trials; new products which don’t
fit within traditional strictures can be tested in the “regulatory sandbox”
tailored to individual products; agile licensing for new drugs keeping up with
the pace of innovation and establishing better means of communicating with
Canadians. This new approach will involve looking at and perhaps adopting
international regulatory practices and application to specific drugs and
elements.
HEALTH CARE INNOVATION, Hon. Mary Ng, Minister of Small Business, Export Promotion and International Trade
She spoke about her focus on innovation both by the private sector and
by government and developing a fast track review process for game changing
drugs.
She explained that the federal government’s CAN Health Network is an
attempt to keep innovators in Canada and their products in Canada. It is to
facilitate the adoption of Canadian health care solutions through offering
innovators a single window through which they can access opportunities and
investments. Companies can grow through Canadian health care purchasing and
from there create global companies with jobs in Canada. These companies will
also be able to take advantage of the trade agreements negotiated by the
government.
The Network will encourage collaboration among scientists in
public-private partnerships creating opportunities for innovation with real
solutions which can be sold around the world; Canadian entrepreneurs growing and
prospering “bringing solutions to the world” while providing better care for
Canadians.
ADOPTING INNOVATION ON THE FRONT LINES, Alex Munter, President and CEO Children’s Hospital of Eastern Ontario and Jodi Butts, Independent Board Member
This session was as advertised, a real view from the front lines of
care, the need for acceleration of innovation and clearing roadblocks.
It is Munter’s view that the biggest challenge in health care is NOT
ageing but chronic disease in children’s health. Among many problems he
highlighted childhood obesity.
He listed five issues that stand in the way of progress by
organizations like CHEO. First, the system is undercapitalized, resulting in
huge capital deficits. Second, micro-management of operations by the provincial
government to the extent that every day is a compliance exercise, taking time
and personnel away from delivering care. Third, privacy legislation which was
written before the development of today’s technology has to be navigated daily.
Patients should own their data. Fourth, there is excessive rigidity hampering
the delivery of care. Fifth, hospital based research is extremely fragile as it
competes with all other hospital needs for funding.
In discussion with Jodi Butts Munter explained he is establishing an
“improvement culture” at CHEO by which employees are encouraged to bring
forward ideas for improvement. This he believes will foster employee
engagement. He looks on virtual care as a great opportunity so that people
don’t have to come to the hospital but realizes there are still privacy issues.
Their last discussion concerned shrinking human resources as he said “we’re
running out of people.”
GLOBAL CONTEXT, GLOBAL RISKS, Dr. James Orbinski, Dahdeleh Centre for Global Health Research, York University
In this important discussion Orbinski focussed on technology in the
context that we need to understand the socio-political implications of
employing or adopting technology.
Values matter in the deployment of technology. It has to be looked at
through the lens of equity, fairness and justice. Then there is the effectiveness
and excellence of technology to be considered. And the fact that technology
should be provided to those who need it most.
Technology, he explained, is not free of value implications. There are
clear choices and values to consider when it is deployed. He used climate
change/global warming as an example of an issue that we need to confront as it
has grave implications for our future as the globe heats up.
The world is different now than it was ten years ago. There is now water
scarcity and failing crop yields which has implications for migration
throughout the world and possible conflict; conflict which is regional and
borderless with global impact. There is a dynamic between climate change and
fragile states and in this case how we use technology matters!
Values matter in the use of technology and innovation.
THE 3P’s OF HEALTH POLITICS IN 2020—PHARMACARE , PROVINCES AND PANDEMIC, Tim Powers, Summa Strategies, Anne McGrath, National Director, NDP and Peter Cleary, Santis Health
The role of this panel was to place a political overview on some of the
topics discussed during the day. There was agreement between Powers and McGrath
that the Liberals are governing as if they have a majority but that health care
is not a priority. Powers pointed out that
governing is more complex now than ever. McGrath’s view is that there will be
an election when the Liberals want one. Cleary’s view is that the government is
governing well and is functioning as a minority.
On health care McGrath noted the looming pandemic and provinces want
more money for health care, not for pharmacare. Powers believes that provinces
want to get health deals done and should include mental health. Cleary offered
that instead of pharmacare, provinces have their own priorities.
Is there a political risk for the government in not getting pharmacacre
done? McGrath believes that not getting it done could be a risk but the
government may put the blame on the provinces. However when not doing
pharmacare is combined with no action on electoral reform then there could be
an accumulated risk to the government. Powers added that it could be framed as
another broken promise.
McGrath believes Canadians want health care improved but doubts that
the Liberals will do it. Powers believes it could be part of reconciliation.
Regardless, as the panel seemed to agree, the spring budget will pass as the
Bloc will support it.
On pandemic preparation McGrath noted that the Liberals have not
successfully dealt with big issues but dealing with a possible pandemic,
communication with the public is key. Also the government should be looking to
the Medical Officer of Health for advice and leadership.
CONCLUSIONS
- Innovation is vital to optimal health care delivery in Canada.
- With regard to virtual care, regulators and
governments must keep up with innovation in health care delivery or get out of
the way. The healthcare system needs to be agile.
- Costs of health care delivery are rising but could
be addressed by eliminating the fiscal imbalance which presently exists between
the provinces and federal government.
- If pharmacare is delivered, it will come in the
form of filling existing gaps.
- Innovation can be an economic driver and a wealth
creator.
- Innovation can allow patients to have their own digital health platform, which can be shared with family.
- Productivity in the delivery of health care must
be improved.
- The development of regulations must keep pace with
innovation so that regulations do not become a roadblock.
- Alex Munter, CEO of CHEO offered that the biggest
challenge in health care is not aging, but children’s chronic diseases.
- Values matter in the development of innovative technology