Delegate Recommendations
Question 4: "Appropriate and Affordable Funding"

Calgary, Alberta
February 25 - 27th, 1999

Group A

We recommend that Albertans have the following responsibilities to preserve and protect their own health:

1. Regular checkups
2. Education
3. Healthy living
4. Lifestyle choices
5. Follow MD instructions
6. Proper diet
7. Learn about resources
8. Become more aware of spirit/mind/body and the balance
9. Immunization of children
10. Develop community connections
11. Family planning
12. Support measures to prevent injury e.g. speed controls (radar), gun control, VLT removal, chemical, environmental pollution, IV drug addicts, all public policy initiatives
13. Avoid abuse of system i.e. unnecessary MD visits

We recommend that Albertans be assisted in meeting those responsibilities by:

1. Promote wellness - e.g. revive "high profile" programs such as Participation -This promotes public confidence; -Proactive approach to health & wellness
2. Wholistic approach to health
3. Recognize links to social services/education /labour systems
4. Educate life-long pursuits- start in school systems - early age
5. Changes in work place regulations (Occupational Health and Safety) -includes monitoring regulations - use of breaks in workplace to combat absenteeism
6. Focus on resiliency supports e.g. "healthy families" models
7. Info for Albertans to make informed decisions
8. Increase awareness of health dangers (e.g. smoking, drugs) amongst students
9. Cleaner air - emission standards be strengthened
10. Better food controls e.g. pesticides
11. Accountability /Self-responsibility- "own your choices"
12. "Selective" rationing or user fees where there is obvious risk taking, abuse of the health system - Why should health insurance be different than auto, life insurance?
13. Market place concept - people can "shop" for services with their quota of health care $
14. Place quality of life issues more in the "public eye"
15. Full disclosure on chemicals in foods and the environment- industry is currently policing itself and this is not adequate

Group B

Our recommendations on the process for funding decisions in the future are:

1. We recommend that stakeholders make best efforts to define the goals and core services for health in Alberta. (no consensus)
2. We recommend that whatever we do regarding funding decisions for health that they be made in the context of how it impacts education, social services and infrastructure.
3. We recommend that a framework of guidelines based on moral and ethical considerations for health care services be developed.
4. We recommend that we do not collect a separate health care premium, but rather collect it from income tax returns. (no consensus)
5. We recommend that the government explore/expand and pilot models involving collaborative delivery of services involving doctors, nurses, practitioners and other expanded teams in each of the regions.
6. We recommend public health care dollars should be dedicated to not for profit delivery whenever possible. (no consensus)
7. We recommend revisiting federal/provincial funding mechanisms/transfers for First Nation people with input from the First Nation people.

Group C

Our recommendations for an appropriate and affordable funding level for health in Alberta are:

1. Until we come to a consensus on what an appropriate health system we cannot come to a consensus to an appropriate funding level
2. 5 billion, 55 million to cover the current system (D - 19)

Our recommendations on the process for funding decisions in the future are:

1. A cap must be set for Health spending (D)
2. Decision on funding should be based on evidenced-based needs (specific areas) - prioritize
3. No new pay increases [to keep up with CPI (D - 13 ) - ]-suggestion, but not agreed to by the group
4. Future based emphasis on "holistic" or total health and prevention (D - 1)
5. Maintain consistent population/inflation adjusted funding (D - 7 on the including the following point; independent of oil price, GDP, revenue and other spending)
6. Shift the discussion from "how will we fund?" to a discussion around how can we create a reformed health system, which would be appropriate, integrated and sustainable? A reformed health system would focus on building increased capacities of individuals, families and communities to meet the health needs and goals of Albertans.
7. Provincial board consisting of various health care professionals, economists, provincial health ethics network, public/community and government representatives with legislative power for spending priorities (no consensus on this point)

Group D

Our recommendations on the process for funding decisions in the future are:

1. That the public be brought into the budget process by becoming informed of health care costs and helping set priorities of what is funded
2. That the Innovation Fund (Laing's Report) be established.
3. Government stakeholder reps and consumer groups set a maximum percentage of the provincial budget for health.
4. An open, honest budget planning process.
5. That funding and budget setting within the health care system be based on the following principles, 3-5 year budget and planning horizon, effective accountability mechanisms, equitable allocation by RHA's, allocation based on effectiveness. (no consensus)

Group E

Our recommendations for an appropriate and affordable funding level for health in Alberta are:

1. Spending decisions made at the local level -fixed amount of money -when you run out you run out
2. Educate the public about health care costs
3. Society needs to be more realistic of costs for health care- need to make tough/ ethical decisions
4. Elected officials make decisions after informed public consultations and be held accountable for their decisions
5. Think long term in planning and funding (8-10 yrs.)
6. Distinction of what is short term and long term made at the provincial level (top down)
7. Ombudsperson in each RHA to advocate for the disadvantaged
8. To educate health care professionals to what a reasonable salary increase expectations is in light of health care budget
9. Educate the gatekeepers of the system of the cost of procedures
10. Validate decision making ( a priority and funding with periodic monitoring and assessment of success - this is inclusive of government. health care practitioners , the public and complementary practitioners and alternative modalities
11. Separate, innovative funding in delivery of Healthcare services across RHA's
12. More of a multi-disciplinary approach that is cost effective with out detriment to care
13. A comprehensive date management system to prevent duplication of services
14. Should be a contingency plan for funding

Our recommendations on the process for funding decisions in the future are:

1. Division re health care funding must consider that they are not "an island" and must examine impact of matrix of other interventions of ministries other than Health on success factors
2. Fix ratio % of program spending between government programs & health care spending - 30% - those we can't fund funded by private sources - disadvantaged would be fully funded

Group F

Our recommendations on the process for funding decisions in the future are:

First step: Strike an all party committee of the legislature to make evidence-based decisions to determine % of government spending on health CARE

Second Step: Develop a Commission - a group of people capable of making decisions 60% public 40% stakeholders to determine how to get maximum value from the money to be spent (based on the core values from Health Summit '99 - F group)

Group G

Our recommendations for the following questions are

What do we need to do next?

1. In order to be truly cost-effective RHA's & Provincial government need to be accountable for total public and private health spending, the public spending to 35% of the provincial budget.
2. Give RHA's clear authority to carry out there mandated responsibility
3. That Alberta take direction from other countries with more efficient health care delivery
4. Establish process that will rationalize services to align services with available resources

Where to from here?

1. Access to health care technologies and MD role be separated and that costs be monitored and fiscal realities be acknowledged by all involved parties
2. Maintain one payer, publicly funded & direct health system
3. Deliver health services only through public, not for profit service organizations (this is contentious one - no consensus)
4. That public consultations continue
5. That the public be educated regarding living wills/personal directives

Group H

Our recommendations on the process for funding decisions in the future are:

1. Political process and management should be transparent
2. More accountability on every level: government, RHA's, individuals, health professionals, and consumers
3. Long term plans should be developed
4. Should be evidence-based decision making
5. Provincial solution not just a regional solution - provincial integration
6. Implement the Bonnie Laing Report - public input; address number of shortfalls
7. New models of delivery should be looked at to determine if: a) improved, comprehensive care can be introduced; and b) this care can be done more efficiently and at a lower cost
8. Look at the whole dollars that are spent on health care, not just the federal/provincial money, but health premiums and individual
9. Prioritize - Decisions on core services to be provided
10. Change the governance process to minimize political influence and turf protection
11. Public, professionals, ethicists, politicians must be involved in some of the expensive end-of-life decisions (no consensus)
12. Elected politicians have ultimate responsibility and accountability (no consensus)
13. Block funding - proportion - % of provincial budget (no consensus)
14. Health care costs should be expressed as % of GCP for the country rather than % of provincial budgets to realize the real costs to Albertans

Group I

Our recommendations on the process for funding decisions in the future are:

1. Explore different funding models.
2. Educate Albertans re: determinants of health, ethical principals, cost of health services in order to manage expectations and promote healthy behavior.
3. Long term planning based on health outcomes.
4. Fund scientific research and outcome education that is population based, promotes efficiencies, considers innovative models of health care.
5. Public and stakeholders have input into health spending.
6. Coordination of decision-making based on health determinants.
7. Setting priorities as a way to control spending.

Group J

Our recommendations for an appropriate and affordable funding level for health in Alberta are:

1. Twelve participants felt an appropriate and affordable level funding level would be the same as at present or slightly more.
2. One participant felt it should be less.
3. Five felt it should be more.
4. One thought it should whatever it needed to fix the system.