Louise Ogilvie, vice-president, corporate services, with the Canadian Institute for Health Information, talks about our healthcare system and CIHI’s role.

What is the Canadian Institute for Health Information (CIHI)?

CIHI is a private, not-for-profit organization. Our mandate is to produce good information on the healthcare system. We try to respond to two questions: How healthy is our system? and How healthy are Canadians? We develop standards around how to collect good quality data. We analyze [the data], produce reports and then disseminate those reports and findings.

To whom are the reports sent?

Policy-makers (who are developing health policies), managers of health systems (those running programs or facilities) and the public, so they have a good understanding of the issues, such as how much we’re spending on healthcare [and] what the quality of services is like. Our reports are published free of charge on our website.

Do you offer education services?

We do have a large education program. Last year, we offered [more than] 300 courses to [more than] 9,000 clients across the country. They typically revolve around helping people understand the standards related to the data, how to collect the data so that we get good quality data, [and] how to understand and use the data in our reports to help support [clients] in their decision-making.

In some cases, [the education is] around the reports or the indicators that are in the reports and helping them understand what that means for their facility—how to interpret the findings. In other cases, it might be around how can managers use data that they collect according to our standards to determine how to make a case for opening up a new unit, for example, or developing a new home care program.

We deliver education through a variety of different means: face-to-face workshops, e-learning programs [and] Web conferences. And we also host a number of different conferences or partner with other groups to hold conferences on specific topics.

What are the recent numbers for healthcare spending in Canada?

What we found is that our health spending is increasing faster than the rate of inflation and the growth of the population. In 2007, we spent $160 billion on healthcare. That comes to about $4,900 per person. And in terms of the split between the private and public sectors, the public sector accounts for about 70% of that funding and the private sector accounts for about 30% of that. And when we talk about private sector spending we’re talking about what people would pay out of their pocket or through privately insured programs. So, for example, employer-sponsored benefits programs would be included in that.

And drug spending?

In 2007, [it was] $27 billion of the total, which is about $820 per person. And if you take total drugs, it’s made up of prescribed drugs and then the non-prescribed drugs. Prescribed drugs are, by far, the largest component. It’s about 83% of the drug expenditures, with the non-prescribed [over-the-counter] being 17%.

Overall health spending increased 6.5% from 2006 to 2007. For drugs, the spending increased by 7% from 2006 to 2007. Prescribed drugs costs are rising faster than the non-prescribed drugs. [The] annual rate of increase was about 8% and the non-prescribed was about 6%.

Are there any trends in spending this year? Or in the last few years?

Over the past few years, the trends have all pretty much been the same. I think, in terms of overall health spending, what’s probably more interesting is if you go back in time, back to the early to mid-1990s. In the 1990s, we saw really slow growth—[around] 1% growth annually, rising up to the peak in 2000 of 8% annual growth and then slowly starting to come down and [become] more stable over the last few years, between 5% and 6%.

What caused this?

In the mid-1990s, there were lots of cutbacks that were happening in the health system—primarily hospitals, because hospitals are the largest sector for healthcare spending. And then we started to see some reinvestments. With some of the health accords, federal transfers to the provinces were starting to have reinvestments in the healthcare system—back into hospitals, medical technology, physicians.

What about public and private trends? Is there a difference?

The trends in health spending for the public and private sectors have been similar over the past 10 years.

Does this vary in sectors or regionally?

There are some regional variations, but overall, it’s pretty consistent.

Do you have data on other health issues such as cancer or cardiovascular disease?

We do produce a report with StatsCan around health indicators. The cancer data comes from StatsCan and their most recent data is from 2004. What it shows is that the incidence of all cancer cases in Canada was 390 per 100,000 people. They do have data on different types of cancers. Breast cancer is 96 per 100,000, and the prostate cancer is 121 per 100,000.

Regarding cardiovascular disease in one of the health surveys (the national population health survey that StatsCan did), 15% of the population reported as having been diagnosed with high blood pressure.

CIHI has information on hospitalizations related to cardiovascular disease. We have stats that show that 10% of heart attack patients die in the hospital within one month of admission for the heart attack. And if you compare that to strokes, 18% of stroke patients die in the hospital within one month of being admitted for the stroke.

What is the most surprising finding you’ve discovered recently?

What is surprising is [the areas] where we don’t have good data to report on.

One area is patient safety. We’re trying to improve that, looking at, for example, quality-of-care issues [and] adverse events in hospitals. We’re working on developing a system to look at medication incidents in hospitals and to have a better understanding [of this] so that we can ultimately try to prevent these from happening in the future.

[Another] is primary healthcare. We know provinces have been changing the way they deliver primary healthcare across the country, yet we really don’t have a good understanding of what works [and what] the best models around primary healthcare [are, such as] changes in physician payment plans. There’s a big gap in terms of primary healthcare and just trying to get data in a standardized way so we can analyze it.

[Finally,] community mental health. We have good data for mental health in hospitals, but once you get out into the community, it’s not as well defined. A lot of those services are provided through the social services system as opposed to the more traditional health sector system. So there is a gap in terms of our understanding of community mental health services. We’re starting to do some initial work now to see if we can get some better information to shed better light on that.

How do we compare to the U.S. in terms of healthcare spending?

In 2005, Canada spent, on average, US$3,300 per person, whereas the U.S. spent approximately US$6,400 per person. [But] spending more may not necessarily be better. You have to look at other health indicators as well. For example, our life expectancy is longer than the average life expectancy in the U.S., yet we spend considerably less per person on healthcare.

What are the health trends that plan sponsors should be aware of?

When I think about the employer, three things come to mind. One is the rise in chronic diseases. Employers should think about how to encourage an active, healthy lifestyle within their workforce. [For example,] supporting memberships to fitness facilities, having a fitness facility on-site or organizing lunch walks.

[Two] is mental health. There’s more and more attention being paid to mental health. In terms of employers, they should be thinking about things like EAPs to help look at stress in the workplace. A lot of employees are stressed because of things happening outside of work. Are employers able to offer things like flexible time or family leave?

[Three is workplace] injuries. And most [of the] time these injuries are preventable. Employers should identify where the risks are, making sure they have good prevention programs in place.

Has CIHI done any studies on these trends?

We do reports around mental health. For example, we collect data on hospitalizations related to mental health in Canada [and] produce an annual report on that. I think once you get outside of hospitals, there are a lot less statistics available in that particular area. Statistics Canada has done a fair bit of work around trying to get better information from population-based surveys in the area, for example, on mental health.

What about chronic diseases?

Most of our data would be related to hospitalizations for these things. But we do put out a joint publication with StatsCan. StatsCan does have a survey that collects data on diabetes. The most recent survey was done in 2005 and what they found was that 5% of Canadians reported being diagnosed with diabetes.

We see that there’s a higher incidence of that; it’s on the rise. It’s a chronic condition that, for the most part, can be managed fairly well outside of the hospital and can be well controlled. Again, it’s trying to make sure that people understand that they have diabetes, that they make sure that they’re treated for it and that they follow their treatment. Diet’s a big contributor [as well as] exercise. Again, it’s that whole promotion of a healthy lifestyle.

Which an employer can promote…

That’s right. And if they’re smoking, can the employer look at perhaps having somebody come in and sponsor a smoking cessation program? In our organization, we had Weight Watchers run a clinic for a while.

What can employers do to educate employees on these issues?

Be familiar with reports affecting the health status of their employees and some of the factors that influence health in the workplace—for example, the impact of obesity or chronic diseases. Inform their staff [by] bringing in speakers or sponsoring programs.

What can Canada learn from other countries?

When we look at other countries, it’s important to look not only at their overall spending, but also [at] how their health systems are structured and the split between the public and private sectors. For example, Canada is among the countries that have the lowest share of public funding for drugs. It’s important to look at those countries to find out what they’re doing—[and] learn from their example.

Do you have any advice for employers on how they can use the CIHI reports?

We produce lots of information and the health of employees is really important to an organization. Obviously, they want to have healthy employees, and it will help them in terms of the productivity. It’s really important to understand what the factors are that affect people’s health and how can they support their employees.

Brooke Smith is the associate editor of Benefits Canada.

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© Copyright 2008 Rogers Publishing Ltd. A shorter version of this article first appeared in the November 2008 edition of BENEFITS CANADA magazine.