Ministry Role and Services

Ministry Overview

The Ministry of Health Services provides funding, support and leadership to BC's health authorities and other partners in delivering quality, appropriate and timely health services. The ministry primarily acts as steward of the system by: developing legislation, policy and standards; setting immediate and long-term direction through strategic planning; and monitoring, evaluating and reporting on system performance. The ministry's partners deliver the vast majority of health services to the public, although the ministry still delivers a small percentage of services through the BC Ambulance Service, Vital Statistics Agency, PharmaCare Program and Medical Services Plan.

Since 2001, the ministry has been leading a significant redesign and reform effort to build an accountable and sustainable publicly funded health system that meets the needs of British Columbians.

One aspect of reform, the consolidation of health authorities from 52 to six, introduced a simpler, more accountable governance model for health service delivery. Now, five regional health authorities oversee the majority of health services in communities, such as emergency and acute care, while a provincial authority manages specialized health services, such as cancer care.

Within these roles, the ministry and health authorities have strengthened partnerships to build a more effective and sustainable system. To improve accountability and quality of care, performance agreements between the ministry and health authorities were introduced in 2002/03. The agreements establish objectives and performance measures for BC's health authorities and health system.

The partnership model is crucial to the success of health system reforms. As reform efforts are primarily focused on improving services, the ministry's success is largely reliant on productive working relationships with those who deliver services. The majority of the performance measures and targets in the ministry's service plan are related to services delivered by health authorities and other partners (e.g., physicians). In 2003/04, the ministry worked with health authorities to continue to improve the performance agreements, and explored opportunities to strengthen relationships with other service providers.

Ministry Vision, Mission and Values

Vision

A health system that ensures high quality public health care services that meet patients' needs where they live and when they need them.

Mission

To guide and enhance the province's health services to ensure British Columbians are supported in their efforts to maintain and improve their health.

The top priorities are renewing public health care while providing high quality public health care services that meet patients' most essential needs.

Values

A set of beliefs, consistent with the principles of the Canada Health Act, defines our organizational behaviour:

• Patient and consumer focus which respects the needs and diversity of all British Columbians.
• Equity of access and in the quality of services delivered by government.
• Access for all to required health services.
• Effectiveness of delivery and treatment leading to appropriate outcomes.
• Efficiency, providing lowest cost consistent with quality services.
• Appropriateness, providing the right service at the right time in the right place.
• Safety in the delivery of health services to minimize the risks to the health and safety of British Columbians.

Ministry Operating Context

British Columbians are generally healthy and have a quality health system they can depend on. Among other positive measures, British Columbia has the highest life expectancy, lowest smoking rate, and highest rate of physical activity of any province in the country. The Provincial Health Officer's 2002 Annual Report, released in 2003/04, confirms the population's healthy state while acknowledging some areas where improvements could be made. Tracking social, economic, environmental, and health conditions across the province, the report gives a broad snapshot of the health system and the health of the population. Of the 91 indicators used, 41 showed improvement, 31 remained relatively unchanged, five had no trend or recent data and only 14 had a negative trend. (The report can be found at www.healthservices.gov.bc.ca/pho/.)

Challenges and Risks

While health outcomes are generally good, the sustainability of the health system continues to face a number of financial and service delivery challenges.

Cost Drivers and Demand Pressures

Rising costs and demands put pressure on the health budget, including:

• Rising use and cost of pharmaceuticals; higher service expectations; and rapid and expensive technological innovations.
• Increasing pressure from both health care providers and the public for government to fund new technologies, pharmaceuticals and clinical interventions regardless of established effectiveness or value for money.
• Increasing need to update or expand health care facilities and equipment.
• Increasing rate of obesity and incidence of chronic disease.
• New diseases, which result in new tests, drugs and treatments.
• New treatments for previously untreatable conditions.
• Increasing prevalence of public health emergencies such as SARS, Avian flu, and West Nile Virus.

Demographic Trends

Population growth and demographic shifts also put pressure on the health system. Health services tend to be used at higher rates as the population ages.

• BC's population increased by 31,600 persons in 2003, and is expected to increase by 38,800 persons in 2004, 42,400 in 2005 and 45,800 in 2006. In 2000 BC's population was 4,039,200. By 2006 it is forecast to be 4,273,600, an increase of six per cent.
• BC's population is aging. Relative to 2000, by 2010, there will be 26 per cent more people over 65, 30 per cent more over 75, and 63 per cent more over 85. The median age in BC is forecast to reach 40 by 2006. This is up from 35.4 years in 1995.
• Life expectancy is increasing. By 2010, the median age at death will be 80.7 years.
• The health system's workforce is also aging, and attracting and retaining high quality staff in the health sector is difficult at a time of global shortages in health care professionals.

Capacity to Manage Risks

Funding for BC's health system has continued to grow. In 2003/04, government's health budget was $10.7 billion, up from an initial budget of $9.3 billion in 2001/02. That total represents approximately 42 per cent of all government spending, the highest proportion ever and in stark contrast to just 10 years ago when the health budget was $6.47 billion and consumed 33 per cent of total government spending. However, even with these significant funding increases the system is hard pressed to keep up with demand.

The health system's capacity to respond to increased demand is limited not just by resources, but also by structure. Designed at a time when most care was delivered in a hospital setting, the system's original configuration no longer meets today's needs and often provides care in more expensive and less effective ways than necessary. Consequently, a major strategic focus has been to redesign the system to respond effectively to the health needs of today's and tomorrow's citizens. The majority of our 2003/04 service plan objectives relate to this redesign, which includes: emphasizing health promotion and disease prevention activities to keep people healthy and out of the health care system; providing the appropriate level of care in the appropriate setting — for example, moving away from sole dependence on residential care for the frail elderly and disabled, to an appropriate mix of home care, assisted living and residential care; and providing tailored care based on best practices for chronic disease sufferers.

To realize these reforms and build a system that will remain sustainable in the face of the many challenges, the ministry has strengthened the relationship with its health system partners and refocused its role on planning, monitoring and evaluation. In 2003/04, the ministry used the following management approaches to meet its service plan objectives and build a sustainable health system:

• Continued the move to evidence-based decision-making and the application of best practices.
• Making the public aware of how unhealthy lifestyle choices can affect health.
• Streamlining to focus on core businesses and priority issues.
• Developing and implementing standards of care and accountability to improve the delivery of health services and patient outcomes.
• Using formal planning and projection tools to forecast the services that will be required to meet the health needs of British Columbians.
• Fostering cooperative working relations with health system partners.
• Building relationships with other provincial ministries to facilitate the coordination of services.
• Directing, supporting, monitoring and reporting on system performance and accountability.
• Involving experienced staff and external experts with extensive knowledge of the issues facing the system.

Ministry Structure and Core Business Areas

The ministry and its health care partners have distinct roles and responsibilities in creating a responsive, patient-centred health system. Our service providers — health authorities and care providers — deliver the majority of health services to their communities and patients. The ministry oversees the health system and provides stewardship and corporate management to support health service delivery across the province.

Specifically, there are three core business areas for the ministry and the health system:

• Services Delivered by Partners;
• Services Delivered by Ministry; and
• Stewardship and Corporate Management.

Services Delivered by Partners

The provincial and regional health authorities, agencies and care providers are key partners who deliver the majority of health services to British Columbians. These partners have a range of responsibilities, including identifying patients' needs, planning health resources, allocating health care funding, and managing service delivery in regions of the province. Services delivered span beginning to end-of-life care, disease prevention to health promotion, and primary to acute care.

Health authorities oversee the delivery of most of these health services, such as providing public health programs and acute care services at hospitals. Doctors and other care providers are vital partners in ensuring that patients get the care they need.

Services Delivered by Partners accounts for the vast majority of health expenditures ($10.1 billion budget in 2003/04) and is the primary focus of the system redesign efforts detailed in the ministry's service plan and this report.

Services Delivered by Ministry

Health Benefit Operations

Health Benefit Operations provides the administrative services for BC's PharmaCare Program and Medical Services Plan. PharmaCare is the province's drug insurance program, which assists British Columbians with paying for eligible prescription drugs and medical supplies. The Medical Services Plan covers medically required services provided by physicians and certain supplementary health care practitioners.

Emergency Health Services

The ministry delivers emergency health services through the Emergency Health Services Commission and the British Columbia Ambulance Service.

Vital Statistics Agency

The Vital Statistics Agency is responsible for documenting important events for BC citizens such as births, marriages and deaths.

Stewardship and Corporate Management

As stewards of the health system, the ministry provides leadership and support to health authorities and other partners. The ministry manages BC's health system through service plans and annual service plan reports, and legislation and policy. It also establishes service expectations and performance agreements with health authorities.

The ministry supports the system by using planning and projection tools to forecast services required to meet the diverse and changing health care needs of British Columbians. To improve quality of care, the ministry also works with its partners to research and develop provincial standards, guidelines and best practices for service delivery. In addition, the Provincial Health Officer monitors and reports annually on the health of British Columbians, and makes recommendations to the public and provincial and federal governments on improving health and wellness.

Further, the ministry monitors and evaluates health system performance by collecting and analyzing health system data. This enables the ministry and its partners to take evidence-based, corrective action and informs future development of service plans and performance agreements.

Corporate Management includes managing ministry budgets, human resources and business requirements. To fulfill the stewardship role, it is essential for the ministry to manage its corporate functions efficiently and effectively.

Core Business Areas for the Ministry of Health Services

Strategic Shifts and Significant Changes in Policy Direction

In 2003/04, the Ministry of Health Services underwent organizational change to reflect its amalgamation with the Ministry of Health Planning. In January 2004, the ministry assumed the functions of health planning. Both ministries had previously worked in close partnership, and therefore the impact on programs and services has been minimal. Core functions of the former Ministry of Health Planning, including health system planning, public health protection, population health reporting, and legislation and policy development continue under the Ministry of Health Services. Objectives, strategies and performance measures from the 2003/04 – 2005/06 Ministry of Health Planning Service Plan have been incorporated into the Ministry of Health Services' plan and reporting on progress is included in this report.

Another significant organizational change was the establishment of the Knowledge Management and Technology Division. The division was created in November 2003 to enable the consolidation and transformation of information management systems and technology, including the Vital Statistics Agency, into one portfolio, and ensure a coordinated approach in this critical area. This reflects the ministry's commitment to evidence-based decision-making and its desire for better use of health data and information.

The Ministry of Health Services did not undertake any significant shifts in policy or strategic direction during the 2003/04 fiscal year. The ministry identified five key objectives and related priority strategies in last year's and in the current 2004/05 – 2006/07 Service Plan. Four of the objectives relate to services delivered by partners, while one is for services delivered by the ministry. These objectives continue to guide the ministry's and health authorities' planning and operational activities — and are the focus of health system redesign efforts.

Update on New Era Commitments

In June 2001, the Ministry of Health Services began work on implementing 44 New Era commitments for the health system. Significant progress has been made with 34 commitments having been either completed or incorporated as an ongoing part of the ministry's operations. Work on each of the remaining 10 is well underway. For a complete listing of the commitments and their status, please see Appendix 3.