Parallel public health care discussions

On Friday, the provincial government released the findings of its year-long conversation on health in the form of a 1,466 page tome. That tome details what British Columbians - including the 6,600 people who registered for the conversation's forums - had to say about how to renew the healthcare system. And, perhaps not surprisingly, what they said during those forums and in the 12,000 submissions made to the government isn't much different from what British Columbians told the province's Royal Commission on Health Care and Costs back in 1991.

That's when the commission released a 20-page booklet summarizing the results of its consultations - which included 900 presentations and 1,450 briefs. According to the report - entitled A Great System But...What You Told The British Columbia Royal Commission on Health Care and Costs - British Columbians overwhelming felt "an ounce of prevention is still worth a pound of cure. There is a feeling that health education and promotion, and illness and injury prevention initiatives are not prominent enough or adequately funded." And there is a need to "change unhealthy lifestyles that are directly responsible for many of our illnesses."

But, 16 years later, that need seems to remain unfulfilled. The Campbell administration is reporting "Health promotion and disease prevention were two of the most common discussion topics in the Conversation on Health." Indeed, conversation on health "Participants believe that we need a combination of policies and education related to health promotion, lifestyle and personal responsibility for health to encourage healthy behaviours." But that's just one of many similarities between the commission and the conversation on health's findings. The following is a selection.

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"Participants expressed frustration with the lack of collaboration between the federal and provincial governments around serving First Nations communities. They emphasized that increased control on the part of First Nations over their own health care services would help to ensure improved treatment.

Conversation on Health Summary of Input

"The Commission has been told...How federal and provincial jurisdictional disputes confound and complicate attempts to improve native health. How it is inefficent for money to be allocated by bureaucracies who have no idea what policies and programs are needed or are effective for aboriginal people in BC. Native British Columbians ask for the understanding and resources necessary to help change the patterns of ill health that have plagued generations and continue to damage and destroy so many people. Native peoples want to control their own health."

A Great System But...What You Told the British Columbia Royal Commission on Health Care and Costs

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"Participants generally perceive the current approach to performance management to be sub-standard. Insufficient attention to incentives, lack of clear measures or of measures that focus on outcomes, and lack of provincially available data, among others, are the reasons British Columbians think that the health care system needs a
revitalized performance management system."

Conversation on Health Summary of Input

"There needs to be stronger incentives and more practical support for the effective and efficient management of the health care system's resources."

A Great System But...What You Told the British Columbia Royal Commission on Health Care and Costs

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"One issue that came up frequently was the lack of specific financial information related to health care costs. Specifically, participants want to know what the total costs are for any given procedure. They argue that, in the absence of this data, it is impossible to judge the efficiency of any approach, and therefore impossible to know which approach to adopt."

Conversation on Health Summary of Input

"Managing the costs of health care services is impossible if the costs of the services are unkown. Access to accurate information is an absolute prerequisite to good management."

A Great System But...What You Told the British Columbia Royal Commission on Health Care and Costs

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"...participants uniformly believe that there needs to be a long-term integrated plan."

Conversation on Health Summary of Input

"The long term goals of planning and management need to be clearly stated."

A Great System But...What You Told the British Columbia Royal Commission on Health Care and Costs

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"Some British Columbians feel that prescription medications are over-used, and frequently mis-used....Many British Columbians feel that the Pharmaceutical industry is in part responsible for escalating drug costs, suggesting that the marketing of prescription medications and the extended length of patents are two of the leading causes of increasing costs."

Conversation on Health Summary of Input

"The cost of prescription drugs, the improper use of prescription drugs and the influence of pharmaceutical companies on prescribing patterns is also of concern to you."

A Great System But...What You Told the British Columbia Royal Commission on Health Care and Costs

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"...many suggest that the challenges facing residents of rural areas (in accessing health care) are extreme. Other participants believe that rural communities are under-serviced and do not receive the same standard of care as larger communities."

Conversation on Health Summary of Input

"A large number of submissions describe the north and other remote areas of the province as poor relatives in our health care system. You feel that few attempts are being made to address the major health problems or to relieve the need for suitable health care services."

A Great System But...What You Told the British Columbia Royal Commission on Health Care and Costs

"There is widespread agreement that there is a shortage of health care professionals in rural communities such as doctors, specialists, pharmacists, and nurses. Participants suggest it is very difficult to find a doctor in rural areas and especially in rural First Nations communities. They also express concern that people in rural communities do not have equal access to specialized care. Many emphasize that where there are doctors practicing in rural areas, they are often over-burdened."

Conversation on Health Summary of Input

"...the chronic shortage of workers in all fields is a major concern in rural BC....You speak of a need: for health care generalists; for doctors able to handle a wide range of problems, including minor surgery and obstetrics; for community nurses; for professionals trained in the special requirements of rural practice; for specialists of all kinds."

A Great System But...What You Told the British Columbia Royal Commission on Health Care and Costs

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"Many participants highlight the need for accessible, community health services based on community needs. The majority of participants involved in the discussion believe that investment in community care will result in decreased costs and demands in other parts of the health care system."

Conversation on Health Summary of Input

"There is also wide spread support for an increased emphasis on community-based health care, designed and funded to meet the specific needs of our communities."

A Great System But...What You Told the British Columbia Royal Commission on Health Care and Costs

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