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Allocation of health care resources

https://policybase.cma.ca/en/permalink/policy389

Last Reviewed
2014-03-01
Date
2000-08-16
Topics
Health systems, system funding and performance
Ethics and medical professionalism
Resolution
GC00-186
That the Canadian Medical Association work with its divisions and affiliates to determine and proclaim the values that should influence health care priority setting and allocation of health care resources in Canada.
Policy Type
Policy resolution
Last Reviewed
2014-03-01
Date
2000-08-16
Topics
Health systems, system funding and performance
Ethics and medical professionalism
Resolution
GC00-186
That the Canadian Medical Association work with its divisions and affiliates to determine and proclaim the values that should influence health care priority setting and allocation of health care resources in Canada.
Text
That the Canadian Medical Association work with its divisions and affiliates to determine and proclaim the values that should influence health care priority setting and allocation of health care resources in Canada.
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Clinical care to incorporate evidence-based technological advances

https://policybase.cma.ca/en/permalink/policy399

Last Reviewed
2014-03-01
Date
2000-08-16
Topics
Health systems, system funding and performance
Health information and e-health
Resolution
GC00-196
That federal, provincial and territorial governments respond to the health care needs of Canadians by ensuring the provision of clinical care that continually incorporates evidence-based technological advances in information, prevention, and diagnostic and therapeutic services.
Policy Type
Policy resolution
Last Reviewed
2014-03-01
Date
2000-08-16
Topics
Health systems, system funding and performance
Health information and e-health
Resolution
GC00-196
That federal, provincial and territorial governments respond to the health care needs of Canadians by ensuring the provision of clinical care that continually incorporates evidence-based technological advances in information, prevention, and diagnostic and therapeutic services.
Text
That federal, provincial and territorial governments respond to the health care needs of Canadians by ensuring the provision of clinical care that continually incorporates evidence-based technological advances in information, prevention, and diagnostic and therapeutic services.
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CMA Pre-budget Submission

https://policybase.cma.ca/en/permalink/policy14259

Date
2020-08-07
Topics
Physician practice/ compensation/ forms
Health information and e-health
Health care and patient safety
Health systems, system funding and performance
  1 document  
Policy Type
Parliamentary submission
Date
2020-08-07
Topics
Physician practice/ compensation/ forms
Health information and e-health
Health care and patient safety
Health systems, system funding and performance
Text
RECOMMENDATION 1 That the government create a one-time Health Care and Innovation Fund to resume health care services, bolster public health capacity and expand primary care teams, allowing Canadians wide-ranging access to health care. RECOMMENDATION 2 That the government recognize and support the continued adoption of virtual care and address the inequitable access to digital health services by creating a Digi-Health Knowledge Bank and by expediting broadband access to all Canadians. RECOMMENDATION 3 That the government act on our collective learned lessons regarding our approach to seniors care and create a national demographic top-up to the Canada Health Transfer and establish a Seniors Care Benefit. RECOMMENDATION 4 That the government recognize the unique risks and financial burden experienced by physicians and front line health care workers by implementing the Frontline Gratitude Tax Deduction, by extending eligibility of the Memorial Grant and by addressing remaining administrative barriers to physician practices accessing critical federal economic relief programs. RECOMMENDATIONS 3 Five months ago COVID-19 hit our shores. We were unprepared and unprotected. We were fallible and vulnerable. But, we responded swiftly.
The federal government initiated Canadians into a new routine rooted in public health guidance.
It struggled to outfit the front line workers. It anchored quick measures to ensure some financial stability.
Canadians tuned in to daily updates on the health crisis and the battle against its wrath.
Together, we flattened the curve… For now. We have experienced the impact of the first wave of the pandemic. The initial wake has left Canadians, and those who care for them, feeling the insecurities in our health care system. While the economy is opening in varied phases – an exhaustive list including patios, stores, office spaces, and schools – the health care system that struggled to care for those most impacted by the pandemic remains feeble, susceptible not only to the insurgence of the virus, but ill-prepared to equally defend the daily health needs of our citizens. The window to maintain momentum and to accelerate solutions to existing systemic ailments that have challenged us for years is short. We cannot allow it to pass. The urgency is written on the faces of tomorrow’s patients. Before the onset of the pandemic, the government announced intentions to ensure all Canadians would be able to access a primary care family doctor. We knew then that the health care system was failing. The pandemic has highlighted the criticality of these recommendations brought forward by the Canadian Medical Association. They bolster our collective efforts to ensure that Canadians get timely access to the care and services they need. Too many patients are succumbing to the gaps in our abilities to care for them. Patients have signaled their thirst for a model of virtual care. The magnitude of our failure to meet the needs of our aging population is now blindingly obvious. Many of the front line health care workers, the very individuals who put themselves and their families at risk to care for the nation, are being stretched to the breaking point to compensate for a crumbling system. The health of the country’s economy cannot exist without the health of Canadians. INTRODUCTION 4 Long wait times have strangled our nation’s health care system for too long. It was chronic before COVID-19. Now, for far too many, it has turned tragic. At the beginning of the pandemic, a significant proportion of health care services came to a halt. As health services are resuming, health care systems are left to grapple with a significant spike in wait times. Facilities will need to adopt new guidance to adhere to physical distancing, increasing staff levels, and planning and executing infrastructure changes. Canada’s already financially atrophied health systems will face significant funding challenges at a time when provincial/territorial governments are concerned with resuscitating economies. The CMA is strongly supportive of new federal funding to ensure Canada’s health systems are resourced to meet the care needs of Canadians as the pandemic and life continues. We need to invigorate our health care system’s fitness to ensure that all Canadians are confident that it can and will serve them. Creating a new Health Care and Innovation Fund would focus on resuming the health care system, addressing the backlog, and bringing primary care, the backbone of our health care system, back to centre stage. The CMA will provide the budget costing in follow-up as an addendum to this submission. RECOMMENDATION 1 Creating a one-time Health Care and Innovation Fund 5 It took a global pandemic to accelerate a digital economy and spark a digital health revolution in Canada. In our efforts to seek medical advice while in isolation, Canadians prompted a punctuated shift in how we can access care, regardless of our location or socio-economic situation. We redefined the need for virtual care. During the pandemic, nearly half of Canadians have used virtual care. An incredible 91% were satisfied with their experience. The CMA has learned that 43% of Canadians would prefer that their first point of medical contact be virtual. The CMA welcomes the $240 million federal investment in virtual care and encourages the government to ensure it is linked to a model that ensures equitable access. A gaping deficit remains in using virtual care. Recently the CMA, the Royal College of Physicians and Surgeons of Canada and the College of Family Physicians of Canada established a Virtual Care Task Force to identify digital opportunities to improve health care delivery, including what regulatory changes are required across provincial/territorial boundaries. To take full advantage of digital health capabilities, it will be essential for the entire population, to have a functional level of digital health literacy and access to the internet. The continued adoption of virtual care is reliant on our ability to educate patients on how to access it. It will be further contingent on consistent and equitable access to broadband internet service. Create a Digi-Health Knowledge Bank Virtual care can’t just happen. It requires knowledge on how to access and effectively deliver it, from patients and health care providers respectively. It is crucial to understand and promote digital health literacy across Canada. What the federal government has done for financial literacy, with the appointment of the Financial Literacy Leader within the Financial Consumer Agency of Canada, can serve as a template for digital health literacy. We recommend that the federal government establish a Digi-Health Knowledge Bank to develop indicators and measure the digital health of Canadians, create tools patients and health care providers can use to enhance digital health literacy, continually monitor the changing digital divide that exists among some population segments. Pan-Canadian broadband expansion It is critical to bridge the broadband divide by ensuring all those in Canada have equitable access to affordable, reliable and sustainable internet connectivity. Those in rural, remote, Northern and Indigenous communities are presently seriously disadvantaged in this way. With the rise in virtual care, a lack of access to broadband exacerbates inequalities in access to care. This issue needs to be expedited before we can have pride in any other achievement. RECOMMENDATION 2 Embedding virtual care in our nation’s health care system 6 Some groups have been disproportionately affected by the COVID-19 crisis. Woefully inadequate care of seniors and residents of long-term care homes has left a shameful and intensely painful mark on our record. Our health care system has failed to meet the needs of our aging population for too long. The following two recommendations, combined with a focus on improving access to health care services, will make a critical difference for Canadian seniors. A demographic top-up to the Canada Health Transfer The Canada Health Transfer (CHT) is the single largest federal transfer to the provinces and territories. It is critical in supporting provincial and territorial health programs in Canada. As an equal per-capita-based transfer, it does not currently address the imbalance in population segments like seniors. The CMA, hand-in-hand with the Organizations for Health Action (HEAL), recommends that a demographic top-up be transferred to provinces and territories based on the projected increase in health care spending associated with an aging population, with the federal contribution set to the current share of the CHT as a percentage of provincial-territorial health spending. A top-up has been calculated at 1.7 billion for 2021. Additional funding would be worth a total of $21.1 billion to the provinces and territories over the next decade. Seniors care benefit Rising out-of-pocket expenses associated with seniors care could extend from 9 billion to 23 billion by 2035. A Seniors Care Benefits program would directly support seniors and those who care for them. Like the Child Care Benefit program, it would offset the high out-of-pocket health costs that burden caregivers and patients. RECOMMENDATION 3 Ensuring that better care is secured for our seniors 7 The federal government has made great strides to mitigate the health and economic impacts of COVID-19. Amidst the task of providing stability, there has been a grand oversight: measures to support our front line health care workers and their financial burden have fallen short. The CMA recommends the following measures: 1. Despite the significant contribution of physicians’ offices to Canada’s GDP, many physician practices have not been eligible for critical economic programs. The CMA welcomes the remedies implemented by Bill C-20 and recommends the federal government address remaining administrative barriers to physicians accessing federal economic relief program. 2. We recommend that the government implement the Frontline Gratitude Tax Deduction, an income tax deduction for frontline health care workers put at risk during the COVID-19 pandemic. In person patient care providers would be eligible to deduct a predetermined amount against income earned during the pandemic. The Canadian Armed Forces already employs this model for its members serving in hazardous missions. 3. It is a devastating reality that front line health care workers have died as a result of COVID-19. Extending eligibility for the Memorial Grant to families of front line health care workers who mourn the loss of a family member because of COVID-19, as a direct result of responding to the pandemic or as a result of an occupational illness or psychological impairment related to their work will relieve any unnecessary additional hardship experienced. The same grant should extend to cases in which their work contributes to the death of a family member. RECOMMENDATION 4 Cementing financial stabilization measures for our front line health care workers 8 Those impacted by COVID-19 deserve our care. The health of our nation’s economy is contingent on the health standards for its people. We must assert the right to decent quality of life for those who are most vulnerable: those whose incomes have been dramatically impacted by the pandemic, those living in poverty, those living in marginalized communities, and those doubly plagued by experiencing racism and the pandemic. We are not speaking solely for physicians. This is about equitable care for every Canadian impacted by the pandemic. Public awareness and support have never been stronger. We are not facing the end of the pandemic; we are confronting an ebb in our journey. Hope and optimism will remain elusive until we can be confident in our health care system. CONCLUSION

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The future of medicine

https://policybase.cma.ca/en/permalink/policy209

Last Reviewed
2017-03-04
Date
2000-08-12
Topics
Health systems, system funding and performance
Ethics and medical professionalism
  1 document  
Policy Type
Policy document
Last Reviewed
2017-03-04
Date
2000-08-12
Topics
Health systems, system funding and performance
Ethics and medical professionalism
Text
The future of medicine In 1997 the Canadian Medical Association (CMA) embarked on a study of the future of medicine. Two premises guided this activity: (1) the pace of change in the practice of medicine that physicians experienced in the last quarter of the 20th century is bound to increase in the 21st century; and (2) it is essential that the medical profession position itself to influence future developments in medical practice. In order to prepare the profession to anticipate and meet the challenges of the future, the CMA is engaged in a medium- to long-term (5–20 years) planning exercise. This policy statement summarizes the results of the first part of this exercise: working definitions of health, health care and medicine; a vision for the future of the medical profession; and the implications of this vision for the roles of physicians. This work was conducted by an expert project advisory group, which developed background papers on these topics and prepared this statement for approval by the CMA Board of Directors. Definitions Health: is a state of physical, mental, emotional and spiritual well-being. It is characterized in part by an absence of illness (a subjective experience) and disease (a pathological abnormality) that enables one to pursue major life goals and to function in personal, social and work contexts. Health care: is any activity that has as its primary objective the improvement, maintenance or support of physical, mental, emotional and spiritual well-being, as characterized by the absence of illness and disease. Medicine: is the art and science of healing. It is based on a body of knowledge, skills and practices concerned with the health and pathology of individuals and populations. The practice of medicine encompasses those health care activities that are performed by or under the direction of physicians in the service of patients, including health promotion, disease prevention, diagnosis, treatment, rehabilitation, palliation, education and research. A vision for the future of the medical profession Medicine will continue to be a healing profession dedicated to serving humanity. Its cornerstone will continue to be the relationship of trust between the patient and the physician. It will uphold with integrity the values of respect for persons, compassion, beneficence and justice. It will strive for excellence and incorporate progress in its art and science. It will maintain high standards of ethics, clinical practice, education and research in order to serve patients. It will encourage the development of healthy communities and of practices and policies that promote the well-being of the public. It will demonstrate its capacity for societal responsibility through self-regulation and accountability. It will actively participate in decision-making regarding health and health care policy. It will guard against forces and events that may compromise its primary commitment to the well-being of patients. The roles of physicians in the future1 Although the vision and values of medicine are enduring and will remain stable, the practice environment of physicians will change as the medical profession responds to health system and societal influences. This in turn will have implications for the roles of physicians. The traditional role of physicians has been medical expert and healer. This has involved diagnosing and treating disease and other forms of illness, comforting those who cannot be cured and preventing illness through patient counselling and public-health measures. While this role will remain at the core of medical practice, the evolving context of health care requires physicians to assume additional roles to support their primary role. The CMA proposes the following roles as essential to the future practice of medicine (cf. Fig. 1 for their interrelationship). Although no physician will function in all roles simultaneously, they should all have the fundamental competencies to participate in each of these roles. -Medical expert and healer: Physicians have always been recognized for their role as medical expert and healer; it is the defining nature of their practice and derives from the broad knowledge base of medicine and its application through a combination of art and science. This is the foundation for continued physician leadership in the provision of medical and health care in the future. -Professional: There must be renewed efforts to reaffirm the principles of the medical profession, including upholding its unique body of knowledge and skills; maintenance of high standards of practice; and commitment to the underlying values of caring, service and compassion. The medical profession of the future must continue to develop standards of care with ongoing opportunities for continued assessment of competency in order to remain a credible, self-regulated discipline worthy of public respect and trust. -Communicator: Increasing emphasis will be placed upon the ability to gather and communicate medical information in a compassionate and caring fashion, to enter into a partnership with patients when organizing care plans and to provide important information through counselling and the promotion of health. As always, the patient–physician relationship will remain paramount, with its essential features of compassion, confidentiality, honesty and respect. -Scholar: Scholarship involves the creation of new knowledge (research), its uniform application (clinical practice) and its transfer to others (education). It is this strong association with the science of medicine and physicians’ willingness to embrace the scholarship of their practice that is closely linked to their roles of medical experts and professionals. -Collaborator: Health care services will increasingly be provided by interdisciplinary teams throughout the continuum of care from health promotion activities to the management of acute life-threatening disorders to the delivery of palliative care. In the role of collaborator, physicians recognize the essential functions of other health care workers and respect unique provider contributions in patient-centred health care delivery. -Advocate: As the health sector becomes increasingly complex and interdependent with other sectors of society, it will be essential for physicians to play a greater role as health advocates. This may pertain to advocacy for individual and family health promotion in the practice environment; it may also relate to the promotion of improved health at the broader community level. -Manager: In order to provide quality care, physicians of the future must be effective resource managers at the individual practice level, at the health care facility level and as part of the wider health care system. In order to fulfil these roles and participate in communities as integral members of society, physicians need to lead balanced lives. Physicians may sometimes experience conflicts among these roles. The CMA Code of Ethics specifies the basic principles of professional ethics for dealing with such conflicts. Conclusion The CMA has developed this vision for the future of medicine and the future roles of physicians to assist individual physicians and medical organizations to anticipate and prepare for the challenges of the next 20 years. The vision provides the profession with criteria for evaluating proposed changes in how medicine is practised and reaffirms the core values of medicine that must be upheld in whatever system emerges. The CMA invites other organizations, nonmedical as well as medical, to comment on the contents of this statement and its implications for health and health care. The CMA welcomes opportunities to dialogue with others on how the health care system can be improved for the benefit of future patients and society in general. 1The section is indebted to the work of the Educating Future Physicians for Ontario (EFPO) project supported by the Associated Medical Services group, the Ontario faculties of medicine and the Ontario Ministry of Health, and the Canadian Medical Education Directions for Specialists 2000 (CanMEDs 2000) project of the Royal College of Physicians and Surgeons of Canada.

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