Delegate Recommendations
Question 2: "Changes to Delivery and Management"

Calgary, Alberta
February 25 - 27th, 1999

Group A

We recommend the following changes to delivery and management of health services:

1. $ follows client through system to community, home
2. Direct access to primary care providers (more than physicians)
3. Revised and transparent population based funding
4. Facilitate innovative use of technology to overcome diminished access issues
5. Use of Smart Cards
6. Implement more community health centers. NE model
7. Provide more education in community
8. Long term planning in regard to future trends
9. Build on successful demonstration/ evaluation of project models
10. Periodic evaluations of overall systems
11. Performance measurement system based on evidence
12. Reduce #'s of RHA's
13. Reassess status of board representation (elected/appointed)
14. Envelope funding (e.g. mental health, aboriginal) be proportional to population occurrence
15. Build flexible systems
16. Private health care be considered to provide non-essential services (non-agreement)
17. Remove disincentives for team work by professionals (non-agreement)

Group B

We recommend the following changes to delivery and management of health services:

1. That pilot projects be implemented to utilize multi disciplinary and multi sectoral teams and services in a single location
2. Attract, maintain, and train well-qualified professions.
3. Promote optimal use of skills and encourage innovative practice and service delivery by professionals.
4. Explore and pilot funding models for health care providers, physicians, and RHAs.
5. We recommend enhancing resources for public health and community based programs.
6. Encourage responsible utilization of health care resources.
7. That RHAs be reduced to reflect the trade patterns.
8. Strengthening diagnosis and treatment programs by using technology appropriately.
9. Develop standards for medication review.
10. Develop and implement standards of care which are to be reflected in regulations (which are respected for funding)(and enforced).
11. Implement the recommendations in the Laing report.

Group C

We recommend the following changes to delivery and management of health services:

1. To shift responsibilities to other health care professionals capable of providing service.
2. Optimize the participation of caregivers in health management.
3. Review of regional administration and structure with the goals of increasing community ownership in programs and decisions.
4. Increase funding for programs such as AADL & Indian Affairs.
5. To expand the AADL list to include additional assistive devices.
6. Development of information systems: Cross disciplinary; Patient care; Management tracking; Policy decision making; & Tracking Trends.
7. Allow qualified health care practitioners accessibility to test, procedures and limiting prescribing rights.
8. Increase promotion and implementation of tele-health
9. Increase resources for chronic care.
10. Expand pharma care program.
11. Encourage interaction during the education of health care professional with other disciplines.
12. Develop & implement childhood screening programs for identifying persons with disabilities early.
13. The health system must work towards eliminating barriers between all government sectors.
14. When determining the course of action for treatment and prevention consider all societal factors that effect the Health of an individual or community.
15. Users should receive a statement of all services received and the cost of the services (Dissenters)
16. More formal health education and care programs to be required in primary, secondary and post-secondary schools. (Dissenters)

Group D

We recommend the following changes to delivery and management of health services:

1. Financial incentives must be in line with goals of the system "M"
2. Invest in innovation "M"
3. an information system that has the following: comprehensive, master system; consistent data using same criteria, province-wide "M"
4. More accurate health human resource planning to ensure the right professional is providing the right care, at the right time, at the right place and at the right cost and the prevention of severe shortages (includes ongoing education of professionals to meet changing needs of the health care system)
5. An ongoing public campaign to educate Albertans on the cost of service providing health care for better decisions and appreciation of the system
6. Better programming in place for public education, prevention and treatment of addictions, injuries and emotional problems (suicide, chronic depression, etc.) and communicable diseases. "M"
7. Explore and evaluate alternate methods of delivery, including the model of a community health center as a major point of entry to the Health Care system, which offers a full range of services, multidisciplinary and based on community-identified needs.
8. Measuring outcomes to 1) evaluate new technology 2) assist in system and care management 3) assess alternate care deliveries 4) report back to the public to ensure accountability
9. Personal health information systems be developed to make health information accessible to those who need it, and protected from those who have no right to or need for it.
10. That all health professionals and government identify barriers to improved integration of services and remove them so that more effective teams can deliver health care.

Group E

We recommend the following changes to delivery and management of health services:

1. Appropriate care for long-term care beds
2. Decreasing # of RHA's boards, basing them on transportation patterns, facilities, populations with 2/3 elected and 1/3 appointed (to ensure effective accountability)- does not include acknowledge and support of medical alternatives
3. Multi-disciplinary community primary care
4. Provincially funded promotion and prevention programs, developed and administered at the community level
5. Functional organization of RHA
6. Comprehensive data network system
7. The government must use the determinants of health to guide all policy decisions (education, social welfare)

Group F

We recommend the following changes to delivery and management of health services:

1. Be consistent with our core values.
2. "We", the public, demand A VISIBLE PLAN: A realistic and specific, step by step plan laying out the process in which reform will happen; A political commitment to implement the Plan even in the face of opposition due to self-interest.
3. Make a commitment to immediately design and implement primary health care models throughout the province
4. Enable people to live in their own homes with supports
5. Change the way we pay providers to align the incentives of providers, health authorities and government
6. Increased use of information technology where appropriate and cost effective
7. Open financial books to public scrutiny - real specific (provincial, regional, and municipal)

Group G

We recommend the following changes to delivery and management of health services:

1. Adequate resources be allocated to health service components based on identified needs to ensure continuity of care.
2. Accountability must be expanded beyond budgets to include measurements such as patient usage and satisfaction, personal expenditure (as part of total expenditures), and that such measurements be published to the individual and public
3. That health care system provide system of funding physician in order to provide quality care, not forced to practice quantity care
4. That health care encourage "inter and intra" disciplinary cooperation (1) during initial education and (2) on a on-going basis which will decrease duplication
5. That adequate money be allocated to RHA to enable them to fund all providers
6. That gate keeping and triage processes be expanded to include providers of alternatives therapies

For implementation of these changes we recommend:

1. Accountability mechanisms be established to establish commitment, develop what to report, determine frequency, who Is responsible to provide info (Alberta Health, RHA's, provider groups, public, insurers) and measure impacts re: legislation
2. Explore the following options. The doctors are funded through the RHA's budget. Pay doctors on a capitation basis.
3. Increase $ paid per patient but limit number of patients a doctor can see in a day.
4. Contracts/salaries
5. Increased payments for under-funded activities (forms, etc) to reduce costs
6. That adequate money be allocated to RHAS to enable them to fund all providers
7. The Minister of Health implement the necessary process to ensure that providers of alternative therapies are included in the health care system
8. RHA's justify their allocations based on needs assessments of citizens, including providers, and communities
9. An information network be created to give providers timely, confidential access to relevant information.

Group H

We recommend the following changes to delivery and management of health services:

1. Develop a long term plan that will streamline and increase the transparency of governance
2. Encourage multi-disciplinary approaches by: a) redefining the roles and responsibilities of health care providers, reducing turf protection; and b) developing alternative funding models (including physicians fees) and pilot programs
3. Train and retain, in Alberta, sufficient health care providers to meet the needs of our system
4. More emphasis on long term care and the development of a variety of options of care
5. Reorganize mental health services and funding
6. Maintain current resource i.e. facilities; recapitalization; equipment; and more money for technologies
7. Develop and regulate a minimum standard of care delivery for pre-hospital services (on a provincial basis) i.e. ambulances
8. Increased transition from inpatient to community care - clearer paths for clients
9. Clearer definition of core services from Alberta Health

Group I

We recommend the following changes to delivery and management of health services:

1. Focus on planning and accountability including, reduction of RHA's, pharma care, alternative care practices, and measurable standards of quality for all services.
2. All systems influencing determinants of health work together to promote wellness.
3. More human resources back into health care.
4. Change expectations by improved education of public and providers.
5. Create a multi-disciplinary team approach to provide seamless health care.
6. New payment system for providers.
7. New models of primary care.
8. Foster the attitude and support development of effective communication between co-providers and between providers and consumers.
9. Alternatives to the traditional hospital based delivery system.

Group J

We recommend the following changes to delivery and management of health services:

1. Adequate staffing & restoration of full time positions in; acute care, primary care, long term care, specialists in rural areas.
2. Better integration of health care services, seamless transition, true inter-disciplinary teams.
3. Enhanced home care and support (including increased coverage for drugs at home after leaving hospital).
4. Adequate hospital beds, both short and long term.
5. Empower qualified professionals to give appropriate care including the recognition of complementary and alternative treatment modalities - and direct users to the most appropriate care.
6. Coordinated decisions at the community level and coordinated decisions between government departments (Education, Social Services, Health, etc.).
7. Create options to fees for service.