PUBLIC CONSULTATION. Reference guide for the call for briefs

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1 PUBLIC CONSULTATION csbe.gouv.qc.ca Reference guide for the call for briefs HEALTH AND WELFARE COMMISSIONER In a context where health and social services needs are growing and resources are limited, the Health and Welfare Commissioner considers important that the values and concerns of Québec s citizens be known and systematically taken into account in decisions regarding the public funding of health and social services. These decisions, which concern the introduction, maintenance or withdrawal of health or social services from the basket of insured services, are complex and must be made on a regular basis, in Québec as in many other nations. Therefore, the Commissioner believes it is important that any individual or association, group or organization that wishes to express their views regarding the public funding of health and social services do so. CONTEXTUAL ELEMENTS IN SUPPORT OF THE CALL FOR BRIEFS What is meant by basket of insured health and social services? The basket of insured services refers to all publicly funded services, activities and goods, regulated by legislation (both provincial and federal), regulations, agreements, programs and administrative procedures. In Québec, as in Canada, nearly 71% of health services are funded by the public sector and some 29%, by the private sector. 1 The latter proportion is borne largely by individuals or private insurance. In Québec, the basket of services includes both health care and services and social services. Insured health services are predominantly hospital and physician services, that is, services that are considered medically necessary, whether they are associated with prevention, diagnosis or treatment (e.g., of an illness, injury or disability). They must meet medical standards and are provided either on an individual or a population basis (public health), in a hospital or, for some, an ambulatory setting. Under the Act Respecting Health Services and Social Services, insured social services refer to services that are considered necessary for the person s condition, while the notion of socially necessary is not fully established. 1. CANADIAN INSTITUTE FOR HEALTH INFORMATION (CIHI) (2015). National Health Expenditure Trends, 1975 to 2015, Ottawa, CIHI, 28 p.

2 Why focus on the basket of insured services? In Canada, and consequently in Québec, the decision to publicly fund health care and services was made mainly for reasons of equity, as is the case in most Organization for Economic Co-operation and Development (OECD) countries. Over the years, health care and services have evolved considerably, in terms of both effectiveness and quality. In parallel with this development, system costs have increased, not only due to technological innovations, but also due to the growing prevalence of chronic disease, changing population needs and demographic factors such as aging. Today, many OECD countries are facing the same challenge, that of improving the public health system while containing costs, at a time when pressure from patients, professionals or even the health care industry is high. Decisions must therefore be made. On the one hand, interventions that are obsolete or whose effectiveness is called into question are often still being funded; on the other hand, interventions or technologies whose effectiveness has been proven are struggling to be introduced into public systems, while still others, often costly and whose effectiveness has not been proven, are seeking to be included in the basket of insured services. To contain health spending, it is important that the efficiency 2 of care and services, that is, the possibility of maximizing the benefit given the available resources, can be determined, which is not always the case. The need for better management of the basket of insured services has been the subject of many recommendations in the past by commissions and ministerial committees, academics and government task forces. However, determining what should or should not be insured by the public health system is not a simple task. The decision as to what will be included in the basket of services must take population needs into account as well as the quality, actual access to and proper use of such care and services. Decisions regarding the introduction or withdrawal of services from the basket of publicly funded services are often underpinned by values. These values determine the goals a health and social services system sets itself, hence the importance of citizen participation. In addition to enhancing the legitimacy of decisions, citizen participation allows the following objectives to be achieved: respond better to people s needs; increase citizens trust in public institutions; take society s values into account and promote their coherence with political actions; inform citizens better and be accountable to them; give citizens opportunities to express their opinions; develop a greater sense of belonging and responsibility with respect to the orientations of the health and social services system. 2. INTERNATIONAL NETWORK OF AGENCIES FOR HEALTH TECHNOLOGY ASSESSMENT (INAHTA) and HEALTH TECHNOLOGY ASSESSMENT INTERNATIONAL (HTAi) (2015). Health Technology Assessment (HTA) Glossary, [Online], [ (Consulted May 1, 2015). Call for briefs 2

3 What legislation governs the basket of insured services in Québec? The Canada Health Act ensures that certain requirements are respected by the provinces and territories. Thus, in order to receive the transfer payments to which they are entitled, provinces and territories must comply with the five principles that characterize Canada s health system: public administration of the system; universality of health care; accessibility without barriers (commonly referred to as free ); portability (which means that medically necessary care is covered for all eligible residents during absences from their province); comprehensiveness (which means that necessary hospital and physician services are covered). In Québec, the basket of services is governed by the Act Respecting Health Services and Social Services, the Health Insurance Act, the Hospital Insurance Act and their respective regulations as well as the Act Respecting Prescription Drug Insurance. The Act Respecting the Institut national d excellence en santé et en services sociaux (INESSS) sets out the aspects to be considered when drugs are assessed for listing. How are insured care and services selected? Decisions must be made regarding both the introduction of a service into the basket of services and the maintenance or withdrawal of other interventions. While there are formal assessment and decision-making mechanisms for introducing some of these interventions (for example, drugs), for many other types of care and services such mechanisms are less explicit or are not based on clear criteria. Moreover, systematic review mechanisms to determine whether the interventions included in the basket of services are still relevant and effective are lacking. What is the objective of the Commissioner s appraisal work on the basket of insured services? First, the Commissioner would like to enable citizens to develop a better understanding of what the basket of insured services is and the nature of the decisions made in this regard. He would also like to give them an opportunity to have some input in decisions made by policy makers regarding the introduction, maintenance or withdrawal of health or social services from the basket. Furthermore, he would like to support policy makers by enabling them to take citizens values and concerns into account in decision making regarding the basket of insured services. These values and concerns relate, in particular, to the decisionmaking criteria they consider to be most important as well as the principles underlying these decisions. Many stakeholders (experts, policy makers, professionals, citizens and other interested parties) are concerned by the issues associated with the composition and management of the basket of insured services. This is why the Commissioner opted for a rigorous methodological approach combining various complementary forms of consultation. First, a population survey was launched to obtain an initial profile of citizens understanding of the basket of services, the values and concerns they believe should underpin decisions about which care and services should be included as well as the compromises they are willing to make to ensure some degree of coherence with these values and concerns. Concrete examples of difficult decision making were used in the survey to illustrate the sensitive and Call for briefs 3

4 delicate nature of such decisions, stimulate debate and highlight citizens perspective beyond the situations described in the survey. This first step in the process of consulting citizens, representative of Québec s adult population living in private households, also included a sample representative of Québec s regions, which made it possible to capture certain region-specific characteristics. The survey was administered by the firm BIP to respondents, by telephone or online, in August Discussion groups were also held in some regions in order to further examine and improve the Commissioner s understanding of some of the survey results as well as to complete the information collected in the survey. This call for briefs is part of a comprehensive consultation strategy and aims to reach as many citizens and stakeholders as possible, who will be consulted at various times in the course of the Commissioner s appraisal work. In parallel with these various consultations of citizens and other stakeholders, an extensive literature search was initiated and is ongoing. In addition, a systematic and structured exercise is being conducted in order to determine how the values, resource allocation principles and internationally agreed upon criteria are directly or indirectly related. Other aspects will also be documented in a second report. The call for briefs will initially support the Commissioner s reflection for his first report, which will be published in fall 2016 and which will focus on citizens values and concerns. CALL FOR BRIEFS In this call for briefs, the Commissioner would like to hear your views on the public funding of health and social services. You are invited to share, in large numbers, your concerns and the issues you are concerned about with respect to Québec s basket of insured services, including its composition and the associated decision-making processes. You are also invited to indicate any positive aspects that you would like to highlight and any proposals for adjustments that you would like to share. The Commissioner would also like to hear your views on the criteria in the following table, which are commonly used to support decision making regarding the public funding of health and social services. You are invited to comment on the relevance of these criteria, their relative importance, the issues their use might raise, etc. You may add other criteria that you believe are relevant to consider in this regard. Call for briefs 4

5 Criteria selected and used to support decision making The additional benefits of the service (for example, benefits with respect to effectiveness, such as increased life expectancy or improved quality of life, or benefits for safety, such as reduced health risks) The severity of the disease or problem The number of people affected by the disease or problem The urgency of the need The lack of effective care that is already publicly funded The overall benefits for the patient, his family and society The share of costs that should be covered by the government The cost of the service for the government relative to its benefits The robustness of scientific data INSTRUCTIONS FOR SUBMITTING A BRIEF Briefs may be submitted until January 29, All briefs will be made public by the Commissioner on his website after this date. Criteria for writing a brief There are no criteria with respect to format, writing style, number of pages or layout. Submitting a brief You may send us your brief by or mail. We will acknowledge receipt using the contact information provided. Information By csbe@csbe.gouv.qc.ca By mail: Commissaire à la santé et au bien-être 1020, route de l Église Bureau 700, 7 e étage Québec (Québec) G1V 3V9 For further information, contact the person in charge of communications, Ms. Elaine Bernier at or by at the following address: csbe@csbe.gouv.qc.ca. Please circulate this invitation throughout your network. Call for briefs 5