Strategic Context

Planning Context and Key Strategic Issues

The Ministry of Health operates within the broader economic, social and environmental influences that affect the population's health status. Enjoying good health and a high quality of life depends on many factors, including access to quality education, meaningful employment, stable family and community environments, and making healthy lifestyle choices.

Access to high quality health services also has a positive influence on health status. In British Columbia, citizens are supported in maintaining their health by a publicly funded health system, directed by the Ministry of Health and delivered primarily by B.C.'s health authorities and health care professionals. In the past 35 years, the scope of the public health system has expanded beyond traditional hospital and physician services to include comprehensive public health programs, a broad team of service providers, prescription drugs, home and community care and more.

This expansion of health services, along with the realities of British Columbia's growing and aging population is threatening the sustainability of the health system. Government understands the importance of the health system to British Columbians and is working to ensure high quality health services are available now and in the future. A key approach in this task is engaging British Columbians in a Conversation on Health that discusses the complex issues involved in delivering health services and will inform Government about the issues and solutions that matter most to British Columbians. The Conversation on Health, which began in 2006/07, will continue in 2007/08 as a discussion among British Columbians on how to make British Columbia healthier, and how to improve and renew the health system.

In addition to the Conversation on Health, Government has also identified a number of other priority areas for action in the health system. Accordingly, the following areas are priorities for the Ministry of Health, and are featured in this service plan:

• Improving the health and wellness of British Columbia's Aboriginal population.
• Building 5,000 net new residential care, assisted living and supportive housing beds by December 2008.
• Strengthening our primary health care system to better meet the changing needs of B.C.'s population.
• Reducing waiting times in key surgical and medical areas, including cardiac treatment, diagnostic imaging, joint replacements, cancer services and sight restoration.
• Addressing emergency department congestion and improving the effectiveness and efficiency of emergency departments.
• Enhancing mental health and addiction services for those in need.
• Ensuring there is an appropriate supply of health human resources to meet the health needs of British Columbians, now and in the future.

Challenges and Risks

The Ministry of Health and broader health system is significantly challenged by the increasing demand for health services in British Columbia. The most significant factors increasing demand are the province's aging population, a rising burden of illness from chronic diseases, and advances in technology that are enabling new procedures and treatments. In addition, the Ministry is challenged in meeting this rising demand by increasing world-wide competition for health professionals and health workers, and the need to direct investments to maintain and improve the health system's physical infrastructure (buildings and equipment).

The Aging Population

Between 2001 and 2005, the British Columbia population grew by 4.3 per cent from 4,078,447 people to 4,254,522 people, and all of this increase was from the population aged 45 or older. While the population under 20 years old decreased, and the 20 to 44 age group remained relatively constant, the 45 to 64 aged population increased 14.8 per cent and the senior's population aged 65 or older increased 8.7 per cent, with the over 85 year old segment growing faster that any other age group. The table below shows the changes in the population from 2001 – 2005.

Change in Population by Age Groups, 2001 to 2005

The aging population is a significant driver of demand as the need for health services rises dramatically with age. For example, compared to a typical 65 to 74 year old, a typical 85 years or older person uses 3 times more acute care services, 12 times more community services and 25 times more residential care services. In 2005/06 those over 65 made up 14 per cent of the B.C. population, but used 47 per cent of acute care services, 49 per cent of PharmaCare expenditures, 71 per cent of home and community care services and 93 per cent of residential care services. The following chart shows the relationship of age to the use of health services.

A Rising Burden of Chronic Disease

Chronic diseases are prolonged conditions, such as diabetes, depression, hypertension, congestive heart failure, chronic obstructive pulmonary disease, arthritis and asthma, which often do not improve and are rarely cured completely. It is estimated that in 2004/05 over one million people in B.C. had one or more chronic diseases. As most chronic diseases are more common in older populations, it is expected their prevalence will continue to increase as the population ages.

Chronic disease, particularly in advanced stages, creates demand for acute hospital care services. For instance in 2004/05, 39 per cent of coronary bypass surgeries, 49 per cent of dialysis, 62 per cent of lower limb amputations and 70 per cent of retinal surgeries were performed on patients with advancing diabetes.¹ More broadly, a study by the B.C. Centre for Health Services and Policy Research in 2002 found that 5 per cent of the population generally accounts for 30 per cent of health system expenditures, including 30 per cent of physician payments, 36 per cent of hospitalizations and 64 per cent of hospital days.² Further analysis by the Ministry of Health revealed 80 per cent of the high needs patients had at least six complex chronic conditions. Overall, the increasing prevalence of chronic disease and the resulting burden of illness is a significant driver of demand for health services.

Advances in Technology and Pharmaceuticals

New treatments and technologies are improving health care but also creating increased demand by expanding the number of patients who can be treated and changing how and where services can be delivered. For example, before the development of microsurgery and laser treatments, cataract removal was only recommended for people with very serious visual impairment. Now, due to changes in technology, cataract removal is recommended for a wider range of patients and can be done as a day procedure. Similarly, many new diagnostic procedures have been made available over recent years, and MRI, CT scans, and non-invasive cardiology tests are now common diagnostic services.

New treatments, coupled with the aging population, are driving demand across a number of surgical procedures, particularly angioplasties, cataracts and hip and knee replacements. This is demonstrated by the increased numbers of these procedures — between 2000/01 and 2005/06 angioplasties increased by approximately 62 per cent, cataracts by 33 per cent, hip replacements by approximately 47 per cent and knee replacements by approximately 84 per cent, while the general population only increased by 4.3 per cent and those over 65 years of age by 8.7 per cent.

Advances in drug therapy, again along with the aging population, are increasing demand on B.C.'s PharmaCare program. Increased use of drug therapy, newer and more expensive drugs entering the market and the emergence of new diseases and new areas of pharmacology are all creating increased demand for prescription medication. Between 2001 and 2005, the number of prescriptions filled by British Columbians that had some level of PharmaCare coverage increased by 22 per cent and the average prescription per beneficiary increased by 36.5 per cent.

Human Resources and Health System Infrastructure

The Ministry is also faced with the challenge of providing the appropriate human resource and physical infrastructure for the health system. As the population ages so too does the health care workforce. Looming retirements in the health workforce combined with the rising demand for services and increased international competition for health professionals impact the province's ability to maintain an adequate supply and mix of health professionals and workers for British Columbia's health system.

Another financial challenge in delivering health services is the need to maintain and improve the health system's physical infrastructure. The Ministry is faced with the continuous need to update or expand health facilities, medical equipment and information technology to ensure the health system provides high quality and safe health care to British Columbians.

Capacity to Manage Risks

Government has significantly increased funding for health services; however, funding increases alone will not meet the increasing and changing demands placed on the health system. Accordingly, the Ministry will continue to undertake several strategies to ensure the health system is able to adapt and respond to changing demands.

As noted earlier in the service plan, the Ministry is engaging British Columbians in a Conversation on Health to hear what is important to them, what challenges are the most important to address, and what solutions are available to ensure good health and a sustainable health system in the long term. Listening to British Columbians enhances the Ministry's capacity to make the right decisions in meeting the challenges of delivering a publicly funded health system.

The Ministry is also engaging in longer-term planning and employing more integrated approaches to anticipating and meeting longer-term needs. The Ministry has significantly strengthened its data collection and analysis capability, and developed a long-term planning framework that provides structured guidance to ensure health system planning activities are evidence-based and focused on population and patient needs. The improved data and the framework guide the Ministry's planning in key service delivery and infrastructure areas, such as health human resource planning, information technology (including eHealth) planning, and capital investment planning for facilities and equipment. Longer-term coordinated approaches based on evidence derived from sound data and analysis strengthens the Ministry's ability to make the right strategic investments to deliver a quality health system now and in the future.

Further, our capacity to manage change has been greatly increased through the development of an accountable, efficient and responsive health sector that welcomes the challenge of improving services for the citizens of British Columbia. One of our strengths is the streamlined structure of five geographic health authorities responsible for the delivery of health services within their regions, and one additional authority responsible for highly specialized services, such as cancer and cardiac care, province-wide. This structure is well designed to manage the complexity of the health system, take advantage of the ability to adapt to change, foster innovation and make strategic investments across the continuum of care. The British Columbia structure is responsive to the changing needs of the population and well prepared to meet the challenges of an increasingly diverse, growing and aging population.