Community Health Care System Changes
A small, rural community has had, since its founding nearly a century ago, a stable population, including a steady median age and a relatively homogeneous ethnicity. However, in the last 5 years, the area’s natural beauty and its suitability for outdoor activities have transformed the community into a tourist and recreational destination. This has created a fluctuating seasonal population of recreational visitors. As a result, the integrated health care system in the community is experiencing a rise in demand for emergency and urgent care. This is placing economic pressure on the health care system because of government regulation surrounding the delivery of emergency care regardless of the patients’ ability to pay. In this assignment, you will create a presentation for the board of the community health care system that outlines necessary changes and possible innovations to respond to the economic pressure of the demographic changes to this community.Community Health Care System Changes
General Requirements:
Use the following information to ensure successful completion of the assignment:
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
Doctoral learners are required to use APA style for their writing assignments. The APA Style Guide is located in the Student Success Center.
This assignment requires that at least two additional scholarly research sources related to this topic, and at least one in-text citation from each source be included.
You are not required to submit this assignment to Lopes Write.
Directions:
Create a presentation (10-15 slides with speaker notes for each slide) that outlines for the board of the community health care system described above a significant change or innovation that you believe is necessary to provide adequate services and improve quality of care for this changing community. The presentation must include the following:Community Health Care System Changes
A description of the change or innovation
A rationale for the change or innovation. What demographic and/or other changes within the community have precipitated the need for your proposed change or innovation? What practical need will this meet?
An analysis of the steps you will take to evaluate the change or innovation. When will these steps be performed? What are the strengths, weaknesses, opportunities, and threats (SWOT) of the change or innovation?
A description of the impact of the change or innovation on the governance and structure of the existing health care system. (Benchmarks 12.1: Analyze the governance and structure of health care institutions.)
A description of the governmental regulations that influence the implementation of this change or innovation. How will quality of care be affected by the interaction of these regulations and the proposed change or innovation? (Benchmarks 12.2: Evaluate the influence of governmental regulations on quality of care.)Community Health Care System Changes
You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.
Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.Community Health Care System Changes
Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.
The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.
This blog may be considered controversial by some and beyond the purview of a hospital CEO. I am writing it because, as a leader in the system I need to communicate the valid need for change and what is driving that. The need has been there for years. The difference now is the globally-precipitated financial crisis. I am not taking political sides, but I am saying the system needs to change.
It has been widely reported in the media that the province has a $14 billion annual operating deficit and accumulated debt of $237 billion. The accumulated debt represents approximately $17,770 for every man, woman and child in Ontario. The province’s annual revenues were $106 billion in 2010/11. (This is all the money the province collects from taxation and user fees, which are the government’s only source of income.) So the accumulated debt is 2.25 times the province’s annual revenue.Community Health Care System Changes
While there are diverse, if not diametric opinions, on the reason for the deficit and the debt, there is considerable consensus that a major causal factor is the global financial crisis of 2008 and the subsequent anemic economic growth globally. By March 31, 2018, the projected date by which the province has public ally said it will balance the annual books, the accumulated debt is expected to be some $275 billion. The Wall Street rating agencies have been to town and have said that if Ontario wants to retain its credit rating it has to get its fiscal house in order. This mandate will apply to any future government, regardless of political stripe.
One of the ways the province is balancing the annual books is by reducing the rate at which health care expenditures are growing. The government is trying to cap that rate to 2.5 per cent a year. That’s no small order. In the last 10 years, health care spending increases have amounted to more than six and a half per cent a year.
Currently, the province spends $47 billion per year or 42 per cent of its annual revenue on healthcare (hospitals, doctors, home care, long-term care, community care and drugs). So there really is no need to change very much in the health care system as long as we keep spending more, right?Community Health Care System Changes
In my opinion – wrong!
What are hidden in the numbers are three important facts that have profound implications for how health care is delivered.
- The population of the province will grow by a little more than one per cent a year over the next few years. Every one of these additional people will be entitled to health care.
- We are all aging and the impact of this, on health care demand, will result in yet another increase of a little more than one per cent.
- We have to deal with inflation factors, such as increasing costs of supplies, drugs and salaries of unionized and non-unionized employees, and billing rates of doctors.
In real terms that 2.5 per cent will be eaten up by growth in demand through aging and population increases. That means every nickel for increased salaries or supply and drug costs, not offset by improved efficiency, will result in real service reductions unless we quickly restructure how we deliver services.
From a hospital perspective the impact is likely to be greater. In Ontario’s Action Plan for Health Care, the government has also said that it intends to shift certain procedures and care from hospitals to community based care – increasing investment and shifting resources to the community by four per cent a year. Since hospitals are the largest component of healthcare expenditures it is pretty clear that they will be one of the main places from which to take those health care tax dollars. (Physician services are likely to be the other one). This may not necessarily be a bad thing; hospitals are often not the most cost efficient delivery model for many services.
In my opinion there is very little financial wiggle room left to avoid the necessary and needed restructuring of the health care system.Community Health Care System Changes
The suits from Wall Street are watching and the debt rating is crucial. If the province’s debt rating decreases, then the province’s cost of borrowing increases. The government’s ability to fund health care is diminished even more by every dollar spent on interest payments. Any future government will have the same problem.
Furthermore, there is ample evidence demonstrating that the current health care system is not really a system. (Ask most patients trying to navigate through it!) It is inefficient, quality is not consistently high, access is confused with geographic proximity and a high quality patient experience is often lacking.
In my view there is currently enough funding in the health care system (with the proposed 2.5 per cent annual budget growth) to meet patient need during the provincial budget balancing cycle. However, the status quo is not an option if we are to achieve this. We have to fundamentally change the delivery model and create a real “system” not a bunch of fragmented silos.
Here are a few examples of such fundamental changes needed:
- We need to eliminate the fragmented governance and create real integrated delivery organizations that are accountable for quality, access and cost across the continuum of care – this means reducing the number and levels of governance/boards;
- Good quality is more important than proximity to mediocre or poor quality service that is available just around the corner – we must consolidate services to drive quality and cost effectiveness;
- We have too many physical hospitals (particularly in the GTA) – many are aging and are too expensive to maintain – we need to merge and rationalize our physical plant so that we can deliver more and better care more efficiently. (We can pay for much of the upgrades and new facilities from the savings gained by eliminating old plants.)Community Health Care System Changes
- We need to understand and accept the research evidence that shows that aggregating services increases quality and efficiency – this means physicians and other clinicians with specialized expertise need to move and work together in hospitals which will focus on services and patients they are trained to serve;
- Hospitals cannot be all things to all people – many procedures can be done outside a hospital more cheaply, safely and with better quality outcomes;
- We have to deliver care using best practices – Medicine is more science than art these days and using best practices and measuring compliance by all care providers is critical.
In the coming electoral campaigns we will hear much in the way of promises from every political party. The provincial financial numbers paint a serious picture, irrespective of which political party occupies Queen’s Park!Community Health Care System Changes
There is a danger that we will tax our way out of this need to change. Raising taxes to provide more health care funding would be wrong as we would be wasting more money on an inefficient system and delaying the inevitable – fundamental change that is required.
Health care has to change. The way we are presently organized is a barrier to delivering better quality and better value for our limited tax dollars. We need the political will from every party to support change that is necessary and inevitable. Moreover, we need our citizens, and voters, to fully understand the problem, to contribute to the debate on solutions, and to accept and support the solutions required to create a sustainable health care system.
This blog is part of a series we’ve been talking about this year on transforming health care. We will have more to come. In future blogs I will talk about some of the alternatives for the needed restructuring.Community Health Care System Changes