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Quantity tights reserved. 3, 1993 1B hen most people think of health care, they con- W template a service that is required only in times of sickness. And even though society advocates choosing a healthy lifestyle, such as eating the right foods and exercising regularly, few people are seriously con- cerned about their health until they are ill. This level of thinking, combined with other factors, has contribu health care system that is now financially out-of-cont Because it is cheaper to keep someone healthy as ted to a rol. opposed to picking up the costs after an illness occurs, British Columbia is on the brink of redefining and delivering health care services to resi- dents. This initiative will affect all areas of the Province, from heavily populated cities, to the smallest communities and dis- tricts. The process requires an entirely new way of thinking about health—second generation thinking. Officials from the Ministry of Health in Victoria are adamant that by thinking of health in a new light, the way in which health services are planned, delivered and paid for will change dramatically. Speaking from his office in Victoria, Paul Pallan, assistant deputy in charge of preparing a response to the Royal Commission on Health, di d that a ber of p g factors indic “health care”, should soon be redefined. Striving responsibility tops that list, followed by equality and ate that the term for greater_fiscal accountability. Federal transfers and downloading of costs has caused the provincial government to make cut-backs of its own—ultimately affecting the way in which services are carried out in local hospita’ ics. Health care costs are escalating, and the once pe ls and medical clin- received infallible sys- tem of “free health care” is now bloated and out-of-control. As well, the commission outlined that, while the system, if not ab one, it still fails to serve everyone equally. used, is basically a good “There are stark i ies b certain p . For hple, the aboriginal people have a health Status that is far worse than that of the rest of the province,” said Pallan, who also argues that there are further inequities in terms of funding, since some regions will receive more money than others. Victoria has also recognized a power inequity, said Pallan, in terms of decision making. “We now believe that local people should have the power and authority to make their own decisions on how health care dollars are spent in their community.” For the past year, Patlan-has been part of a team that is working towards pub- Dissctiogs Di lishing a paper called the S cific new directions in health care After an earlier draft of the paper was made publi lected and a final document has been achieved. » which will map out Spe- ic in October, response was col- “This document has gone through some fairly substantial changes because of the feedback we received in the fall of 1992. This upcoming release has been deliberate- ly made concrete and specific.” Pallan is hoping the Strategic Directions Document will be released this week, after receiving final approval from Health Minister Elizabeth Cull. The document pfovides a new sense of direction try—including Acute Care, which has quickly ev in all facets of the health care indus- olved into an often guarded subject. Acute care would include all emergency cases, as well as births. Hospital boards across the Province are now focusing on the word “regionalizat ion”, and just what the outcome of such a term will mean to their individual hospitals. Without even seeing the Strategic Directions Document, feelings of territorial rights are showing, “The Regional Hospital.” as key players jostle for the Position of In the West K REDEFINING HEALTH CARR Lake R y alone, the K Hospital in Nelson is exploring the idea of a $27 million renova- tion plan, while the Trail Regional Hospital is eyeing a $14 mil- lion renovation of its own. In Castlegar, City Councillors have been quoted in local newspapers, saying that if a regional hospi- tal serving the West K is to be it should be in their community—due to its central location and airport ser- vices. According to Pallan, Victoria is aware of the territorial taffy- pull regarding acute care services, but is not planning to step in— just yet. “The very fact that people are talking on a regional basis will flush out some of those territorial feelings. Areas like the West or Central Kootenay have to work out how they would like these regional ser- vices to take place, and then submit their Plans to Victoria for approval. But if they absolutely can't reach a compromise, it's likely that sorhething will be worked out for them.” Not only has the funding for both Trail and Nelson’s renovation Projects been put on hold, acute-care beds in Kaslo, New Denver and Nakusp are rumored to be on the chopping block. This has raised con- cems in smaller hospitals about their future roles in the service of health care . This is where the new definition of health care demands full attention. The path towards regionalization of acute care funding and community- based health care is one that has already been travelled by a province rec- ognized for its pioneering role in medicare—Saskatchewan. In January 1992, the ‘Well Project’ was bI: by the Mini of Health to recommend a strategy for health reform. Saskatchewan’s general make-up is that of small farming communities scattered across a windswept prairie. Many of these rural communities (some as small as 400 in population), have their own hospitals with approximately 15-30 beds in each. In fact, Saskatchewan has the most hospital beds per person in the country and more hospitals than any other province in Canada except Ontario. Although these hospitals can deliver a certain degree of acute care, such as: emergency, cardiac care; or trauma stabilization, they no longer perform the same acute Care services they did in the 1960s—even a first-time expectant moth- r might be sent to a larger hospital, possibly in the nearest city, for her delivery. The government has realized that funding a number of acute-care beds in small town hospitals, especially when there is a larger centre close by, is a waste of taxpayers money. The new direction calls for reallocating funds to a broader range of activities Proven to contribute to health—hence, some hospitals could soon be taking on the role of ‘wellness centre’. d that a The change has been wi by those hosp di who duplication of services benefitted no one in the long term. However, some hospital boards in these small communities still consider the change a negative one, and see only lost opportunity and lost jobs. “One thing people have to realize is that the cost for health care far exceeds the benefits realized, and the government can’t keep funding hospitals just to keep people in the commu- nity employed,” said one hospital administrator, who says she is looking forward to that dis- tricts new approach to, and focus on wellness. “What we can do is put our funds and energies into keeping people healthy—that incentive also needs qualified people” Pallan said the provincial government in B.C. has been keeping a close eye on the new direc- tion Saskatchewan has taken, He believes a similar approach could work in this province—but regions such as the West Kootenay have to come up with their own game-plan. “Victoria might support that game-plan, but then again it might not. But the point is, we want these decisions to be made locally, and we're forcing that to happen.” Kootenays Contemplate Change number of initiatives, all of which sur- Aw the future of health care, are cur- tently taking place in the West and Central Kootenay. One of these is called the Kootenay Health Plan, and it involves determining health care strategies for individual communities. . Valerie Young, a consultant from Vancouver, has been hired as a coordinator to carry out the third phase of the process. “This is not so much a study as it is a Process to determine how planning for future health care needs in communitjes should be done,” said Young. Integrated planning will allow communities a chance to define how health care should be deliv- ered, since not every community has the same needs. Young said her involvement in the Kootenay Health Plan will take between nine and 12 months of work, so she is hoping to establish an office some- where in the region which will act as a base. “There's going to be lots of development ahead, and lots of talking”. Young also indicates the Ministry of Health in Victoria will be releasing recommendations on ‘i i g fairly soon—possibly this week. “Other areas in the province realize that regional Planning is coming, but I think the West Kootenay is ahead of the game,” she said. “People are already talking about upcoming changes, not only are they talking, they are working together.” wee, N a separate note, West Kootenay Hos- O pitals are also planning for the future by looking at today's problems, through something called the West Kootenay Hospital Planning Council. The council, which consists of administrators from some of the areas hospitals, has hired a con- Sultant to do some investigating and teporting Geoff Rowlands, the consultant, is with the Stories by Sharlene Imhoff Health Management Resource Group, a sub- Sidiary of the B.C. Health Association. He has been hired to study the population and demo- graphic projections for the total West Kootenay and will define the acute care needs if the area based on its population base. Rowlands will also be looking at the existing roles hospitals are playing in delivering acute care and where the best locations are for future acute care. The communities which are involved in the study include: Grand Forks; Trail; Nelson; Kaslo; New Denver; Nakusp; Cresten; and Castlegar.