Coming back to our census

Judith Shamian is president of the Canadian Nurses Association (CNA) and president and CEO of the Victorian Order of Nurses (VON). She is also a professor at the Lawrence S. Bloomberg Faculty of Nursing at the University of Toronto, a co-investigator with the Nursing Health Services Research Unit, and was the executive director of the Office of Nursing Policy at Health Canada for five years. 

Last summer, the health and research community voiced grave concerns about the government’s decision to replace the mandatory long-form census questionnaire with a voluntary national household survey. Census data are necessary for designing, monitoring and delivering effective health programs and services. Most of us agreed that the decision will result in a less accurate picture of Canada’s demographics, making it harder to allocate resources where they’re needed most.

This issue captured the attention of Canadians, yet it has now fallen off the radar. It’s a shame because our country needs – now more than ever – reliable numbers, targets and measurements to get the most value from its health dollar. Canada’s nurses believe that such information is essential to support smart solutions to health system challenges, including: 

·        national strategies to coordinate research into, and treatment and prevention of chronic diseases such as diabetes and Alzheimer’s

·        a pan-Canadian plan to develop and grow our pool of health professionals

·        electronic health records that can follow individual Canadians wherever they may live

·        national goals, performance measurements and investments in key health areas

·        country-wide tracking of our progress and effectiveness in all of these initiatives

Information from the Canadian long-form census provides the benchmark by which research findings are weighed and verified. Decisions on health and social policy are better when they are based on the best possible data. Let’s hope that a sustained spotlight on the census issue will bring back the best practices in statistical science. A healthy future for all depends on the health system’s ability to accurately direct its resources to the varying needs of the Canadian population.

Health Impact Assessment – Making Whole-of-Government Decision Making Possible

On March 9, 2011, we held our fourth webinar, Health Impact Assessment - Making Whole-of-Government Decision Making Possible.
It drew on our December, 2011 report, Stepping It Up: Moving the Focus from Health Care in Canada to a Healthier Canada. 
For this webinar, we invited three guest panelists: Louise St. Pierre from the National Collaborating Centre for Healthy Public Policy in Montreal; Lyne Jobin from the Ministry of Health and Social Services, Quebec City; and Olanna White from Toronto Public Health.We'd like to thank the National Collaborating Centre for Healthy Public Policy for their valuable assistance in organizing this event.
If you missed the webinar, you can download a playback link by clicking HERE. You can download the complete PowerPoint presentations including references and useful information links HERE. Finally, below are the questions we didn't have time for...

1. If negative health impacts are realized in the future that may be attributable to the project or policy, does the burden of proof remain with the consulted community...or is the coordinator of the HIA accountable to address these issues? Has the tool ever been evaluated for expected outcomes for any project or policy­
2. Could Olanna please provide some examples of concept of 'equity-based' HIA?
3. Besides Quebec and Toronto - are other provinces or territories using HIA and if so - where?­
4. Where are the best sources of scientific evidence re health impacts on social determinants of health?­
5. Olanna, as a follow up to the question on how City of Toronto is using HIA, do you plan to propose to the City that it use HIA as part of process when reports go forward to City Council similar to Equity Lens initiative?
6. How can community health boards use the HIA tool to improve the health of the community­?

You may have your own questions, answers or comments about either the report or what you heard in our webinar. Please post them in the comments section below.

 

How Do Canadians Rate the Health Care System? Our 3rd Webinar

On February 14th, we held our third webinar, What Can We Learn From Top Performing Countries? It expanded on our November 2011 bulletin, How Do Canadians Rate the Health Care System? based on the 2010 Commonwealth Fund International Health Policy Survey. In the bulletin, we found that citizens of certain European countries feel they have the edge in particular areas of health care. 

In our webinar, we discussed those areas and what Canada and other countries can learn. We invited three guest panelists - from the United Kingdom, Nicholas Mays, Professor of Health Policy in the Department of Health Services Research & Policy at the London School of Hygiene and Tropical Medicine in London; from the Netherlands, Dr. Jako Burgers at the University Medical Centre, St. Radboud Scientific Institute for Quality of Healthcare, Nijmegen; from Switzerland, Dr. Monika Diebold, Head of Obsan, the Swiss Health Observatory, at the Swiss Federal Statistical Office, Neuchâtel. 

If you missed the webinar, you can download or playback by clicking  HERE. We apologise that it commences just after the start of panelist Nicholas May's presentation.You can download the complete PowerPoint presentations HERE. Finally, here are the questions webinar attendees asked our panelists...

• Is there additional insurance over the basic national insurance? Is this additional insurance private or governmental?
• How does the health of the population, i.e., more chronic disease, higher obesity rates, etc., translate to higher per capita costs in a country?
• One of the major barriers to moving toward electronic health records is cost. How did the Netherlands and the UK implement computerized systems without incurring unrealistic expenses?
• All three systems use primary medical care as a surrogate for primary care. How are other primary care providers integrated within your primary care solution? How are they reimbursed, fees negotiated and what incentives are there to optimize team-based care?
• In the Netherlands, the average consultation length with a doctor is 10 minutes. Is that time enough?
• How about medical education for GPs? Does your country make use of EMR systems or regional prescribing databases to provide feedback to GPs about their prescribing practices and make recommendations about optimal cost-effective prescribing?
• What are the implications for the issues discussed (access to care, timeliness etc.) in the engagement of patients with the physicians? In the case of Switzerland, have there been any changes or attempts at the patient-physician level in order to address the cultural differences among the four groups?  
• When Dutch residents seek care from one of the 100+ after-hours care centres, are their patient records available electronically to the MDs?
• Are governance models significant in promoting primary care service delivery, for example Regional Health Authorities?
• What is the impact of "culture" on the demand for specialist services in your country? That is, is there any difference in patient expectation or GP attitude between countries that impacts behaviours/expectations respecting access to specialist care?
• What is the NHS' overall approach to managing recently announced cuts to its budget? How do you perceive this will impact service provision?
• A big issue here in Canada is the high number of patients, often elderly patients, occupying acute care beds who should be cared for elsewhere. This contributes to lengthy wait times for elective care and for emergency care. Is this a problem in your country?
• In the Netherlands we are working on the implementation of a National Exchange point electronic health records. Do the panel lists think this might improve coordination? Are there any experiences?
• What about the impact of survey methodology? I suppose you all have the common problem of growing rates of non-responders. Are you worried about that? How do you deal with this limitation?
•  How do England and the Netherlands explain the low marks for patient centered care given the overall comfort with primary care in general?

You may have your own questions or comments about either the bulletin or what you heard in our webinar. Please feel free to post them in the comments section below.