Cutting through the health system information fog: Royal College environmental scan 2017 Edition Introduction This environmental scan is an evergreen document and provides a snapshot in time of various aspects of Canada’s healthcare system. In keeping with previous editions, this reference document provides a national overview of key indicators and trends in the following five domains: • Political environment, • Economic environment, • Socio-demographic environment, • Healthcare system environment: Performance and Human Resources for Health • Technological environment The health policy related events and data captured in this report is drawn from the most recent information that is publicly available at the time of release. As this edition has been drafted in early 2017, the scan largely utilizes sources that were released in 2016. We encourage Fellows and all other readers to contact us at [email protected] if they have any comments, questions, or to suggest new content areas for future iterations of this environmental scan. Political environment On November 4, 2015, the Liberal Party formed a majority federal government. It replaced a Conservative government led by incumbent Prime Minister Stephen Harper, which held office for nearly a decade. Prime Minister Justin Trudeau’s mandate letter to the Minister of Health, Jane Philpott, explicitly called on the minister to deliver on a number of priorities, which included the areas of home care, mental health, prescription medicines, substance abuse, Indigenous health, public health and the legalization/regulation of marijuana.1 To date, the government has developed two federal budgets. The table below outlines some of the key health care related announcements made in these two budgets. Table 1 – The Canadian federal budget, 2016, 2017: Health care highlights Source: Department of Finance, 2016, Budget 2016; Department of Finance, 2016, Budget 2017 2016 Federal Budget 2017 Federal Budget • New funding of $95 million dollars on an • $100 million over five years to support ongoing basis to the research granting the Canadian Drugs and Substances councils, which includes an additional Strategy, aimed at addressing the $30 million to the Canadian Institutes of country’s opioid crisis. Health Research • $828.2 million over five years to support • $39 million over three years to investments aimed at improving health Canadian Foundation for Healthcare outcomes in First Nations and Inuit Improvement to support the communities. organization’s efforts around healthcare • $140.3 million over five years to Health innovation. Canada, the Patented Medicine Prices • $50 million over two years to Canada Review Board and the Canadian Agency Health Infoway, to support digital health for Drugs and Technologies in Health, activities in e-prescribing and tele- aimed at improving drug prices, homecare. prescribing practices and access • $5 million over 5 years to the Heart and prescription medications. Stroke foundation to support research in • $53.0 million over five years to the women’s health Canadian Institute for Health • $4 million dollars over 4 years to the Information” to strengthen health data Canadian Men’s Health Foundation on and reporting on health system men’s health initiatives. performance. • $47.5 million per year ongoing funding • $300 million over five years to Canada to the Canadian Partnership Against Health Infoway, to expand e- Cancer. prescribing, virtual care initiatives and • $25 million over five years to the the adoption of electronic medical Public Health Agency of Canada records. targeted at improving immunization coverage. • $500 million in 2017–18 to develop a pan-Canadian framework on child care and early learning. From a national health accord to bilateral health agreements – the new landscape of Federal/Provincial/Territorial cooperation in health care. • The 2004 accord formalized a ten year agreement by First Ministers on a series of The Federal government has integrated commitments to improve Canada’s health care substantive changes to the CHT through system. The accord established a funding bilateral agreements with the provinces scheme that the federal government agreed to and territories, which raises various transfer to provincial/territorial governments questions around the fiscal burden being mostly through the Canada Health Transfer. placed on provinces/territories in the • In December 2011, the federal Conservative coming decade. government announced that there would no longer be a 6% annual increase (termed as the annual escalator) in the Canada Health Transfer (CHT), the federal funding scheme for health care. It was stated that following the 2016-2017 fiscal year, annual increases in the CHT would be tied to nominal Gross Domestic Product (GDP).2 • In December 2016, the federal, provincial and territorial ministers of health and gathered to discuss this change to the CHT, requesting that the current Liberal government revert to an annual escalator of 5.2%. The federal government countered with an annual escalator of 3.5% and additional targeted funding of $11 billion towards home care and mental health. The ten provinces and three territories rejected the federal government’s offer.3 • Subsequently however, the provinces and territories have come to terms individually with The Federal government has committed the federal government through bi-lateral to jointly develop, in conjunction with agreements. These agreements include an annual the provinces and territories, CHT escalator which will be tied to nominal GDP performance and reporting measures. (with a minimum 3% guaranteed), targeted funds Long-term, this initiative may be the in home care and mental health (see Figure 1 defining feature of leadership displayed below) 4,5,6,7,8,9,10,11,12, and a commitment to by the Federal government in health develop performance indicators and annual care. reporting practices. Figure 1 - Funding agreements on home care and mental health care services with the Federal Government Provincial Developments Apart from discussions on the CHT transfer, there have also been a number of salient developments at the political level as it relates to health policy, over the past year. Some of the provincial highlights include the following: Alberta • The government and the Alberta Medical Association have agreed to implement various financial and non-financial amendments to their physician services agreement, set to expire in 2018. The deal notably introduces a cap on billings (which, if exceeded, is subject to financial penalties for physicians), the development of a blended capitation model option, a new peer-review/audit process and the formation of a Physician Resource Planning Committee assigned to develop a needs-based physician resource plan.13 British Columbia • The government has announced that it will be reducing monthly health premiums that residents pay by half, in 2018. The government anticipates the cut will cost the government $810 million in the 2018-2019 fiscal year.14 • In September 2016, the Cambie Surgery Centre, a private clinic based in Vancouver, led a constitutional challenge of the province’s Medicare Protection Act. The plaintiffs are challenging the province’s ban on the purchase of private insurance for medically necessary services and its prohibitions on physicians practicing simultaneously in the public and private system.15 The case, which is being heard in the British Columbia Supreme Court, has been adjourned until September 2017.16 • The province’s Budget 2017 has outlined various mental health and substance abuse initiatives, totaling $140 million over three years. The funding announcement includes hiring additional 120 mental health practitioners and providing 28 new substance-use treatment beds across the province.17 Manitoba • The provincial government is considering a report prepared by Health Intelligence Inc., a consulting firm which was commissioned by the previous NDP government to investigate the province’s health care services. The report outlines 10 recommendations on reorganizing service delivery, including the consolidation of acute care services in hospitals, the re-branding of select hospitals as convalescent and rehabilitation centers, use of technologies like Telehealth, and adopting new team-based models of care.18 • The government has also contracted a separate consulting group, KPMG, to assess its health spending.19 Although not released publicly, KPMG’s interim report reportedly recommends significant cuts related to staffing (e.g. staffing levels, overtime). 20 • In the coming year, the Manitoba government has set savings targets for its five regional health authorities, which includes a mandate to the Winnipeg Regional Health Authority to find $83 million in savings in the coming year.21 New Brunswick • The provincial government intends to develop a health strategy framed around key determinants of health such as poverty and gender equality.22 The government will showcase the framework for action, titled the Family Plan, at various stakeholder summits planned in 2017.23 • The government’s Council on Aging has produced a report on addressing the province’s aging population following consultations with multiple stakeholders. Focused on ensuring that seniors stay at home and living independently, the report proposes various initiatives such as developing a dementia strategy, enhanced training and recruitment of caregivers, forming age-friendly communities and establishing New Brunswick as an exemplar in