Nordic-Canada Health Solutions Initiative 2018-2019 - #nordicsolutions to global challenges
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#nordicsolutions
to global challenges
Nordic-Canada Health funded by:
Solutions Initiative 2018-2019
Photo: OuluHealth
Initiative background
● The Nordic Solutions to Global Challenges is a joint initiative by the Prime
Ministers of the five Nordic countries to identify and promote Nordic sustainable
solutions and strengths for global challenges
● There was extensive mapping and analysis on Nordic strengths within health
technology
● The strengths identified were sustainable hospitals, smart digital solutions,
assisted living technologies & personalized care (Menon report)
● Executed “go-to-market” programs in the region by some of the partners
Demonstrate stronger combined knowledge and
The initiative’s goal experience
is to strengthen the
Nordic message by Create a more complete solution and value
bringing together proposition to Canadian stakeholders
the five countries to: Combine efforts to gain access to decision makers
and market opportunities
The Initiative will be supported by Nordic Innovation,
the Nordic Embassies and Nordic Trade Promotion Offices
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Agenda
Healthcare in Canada ● Geographical overview
● Healthcare spending
● Allocation of funds
● Patient journey
Key Opportunities ● Hospitals
● Long term care & retirement homes
● Home & community care
Approval Process ● Approval and procurement Canada
Nordic-Canada Health ● Program background
● Details of program
Solutions Initiative ● Partners & facilitators #nordicsolutions
● Application process
to global challenges
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Why Canada?
#1
In the G7 for FEWEST DAYS
to establish a new business #1
(World Bank Group, 2017)
In the G7 for living conditions and
QUALITY OF LIFE
(OECD, 2017)
#1
In the G7 for LOWEST
total effective taxes
(PWC, 2017)
#1
MOST REPUTABLE
among G7 countries
(Reputation Institute’s Country Reptrak, 2018)
#1
Most HIGHLY EDUCATED
workforce in the OECD
(OECD, 2017)
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Introduction to Canada
A stable economy with 36 million people, across 10 provinces & 3 territories
• Six times zones - Canada is the 2nd
geographically largest country in the world
• 86% of Canada’s population is in four
provinces (Ontario, Quebec, Alberta, British
Columbia)
• Provinces have more decision-making
abilities than federal government, leading to
differences in doing business in each
province
• 17% of population is over 65 years old in
2018, expected to grow to 23% by 2030
Canada’s population 2016, millions
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Healthcare in Canada - Spending
Publicly funded: Canada’s health spending is about C$242 billion with a 70/30 public and
private split
• Contributes funding to the provinces and territories on a per capita basis as
Federal Government well as to aboriginal, Inuit and veteran affairs
5% spending • Health Canada manages product regulations, standards and research
including some specific groups (medical devices. pharmaceuticals, natural
products, health research, food, consumer products)
Provincial or Territorial Government • Managed by Ministry of Health and Long Term Care (Ontario) and administered
65% spending own health insurance programs, ex: Ontario Health Insurance Plan (OHIP)
• Responsible for funding and delivery of hospital, community, long-term care,
mental and public health services
• There area 14 Local Health Integration Networks (LHINs) in Ontario
Regional Health Authorities • Covers hospital and physician services, medically necessary diagnostics,
inpatient prescription, long term care and home and community care
Out of pocket: 15% • Additional private insurance, held by about 2/3 Canadians, covers ex: vision
and dental care, prescription drugs, rehabilitation, home care
Private insurance: 12%
• There is no cost-sharing for publicly insured physician, diagnostic, and
Other: 3% hospital services
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Allocation of funds for health services in Ontario
Ministry of Health & Long Term Care
Regional Health Authorities OHIP Public Health
(14 Local Health Integration Networks)
Physicians’ payment
Hospitals Long term care
for services
Community care Mental health &
access centres addiction services
Community Community health
support services services
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50% of Canada’s 2017 healthcare spending includes
only hospital, drug and physician costs
Top 3 areas % health 2016 Investments
of spending spending growth • Federal government has granted $4.2
billion for Ontario over the next 10 years
28% +1.9% • $2.3 billion for better home care
Hospitals • $1.9 billion in support of mental
health initiatives
• Ontario is investing $155 million over 3
16% +4.2% years to improve community-based
Drugs palliative and end-of-life care
• May 2017, medical assistance in
dying legislation passed
Physicians 15% +3.4%
• 2018 - Free prescription medication
for Ontarians under age 25 (4,400 listed
drugs)
How is it implemented?
Health care is largely delivered by private individuals and organizations. These services,
however, are financed by governments through public health insurance plans and direct
funding to health care facilities 8
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Patient care pathway Out of pocket unless
covered by private
insurance (common)
PATIENT Publicly covered
healthcare
$0 co-payment Emergency
care only
Primary Care Dentist, Optometry
Hospital Physiotherapy, Chiropractors,
Doctors
Physiotherapy, etc.
Referrals to Regional Health Authorities
specialist and (Local Health Integration Networks)
testing
Specialist Home care Long term care Private retirement home
• Primary care physicians function as gatekeepers for access to all other health services in the system
• Many family physicians and specialists work as independent contractors billing the provincial insurance
under ‘fee for service’ model with recent slow shift towards alternative payment plans
• Physicians billing has reached C$22.8 billion in 2012-2013. This is growing on a 3.5% annum
average. The average income of a Canadian physician is $320,000 CAD (2012)
• Since 2009, there has been an 8% increase in the number of nurses in Canada 9
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Summary of insights
• Canada is similar to Nordics with its publicly-
funded, universal healthcare system (Medicare)
• Decentralized and provincially/territorially
managed – 13 different markets
• Ontario is the largest province and a
key entry point for healthcare in
Canada
• High spending – need for transformation due to
aging population and increased cost of health
care
• Fee for service is common
• Focus on efficiency with new interest in
innovation, digital solutions, workflow optimization
– showing particular interest in Nordics
• Over capacity for long term care facilities is
causing focus on increasing home care
services
• Changing towards a patient-centric care model
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2Agenda
Healthcare in Canada ● Geographical overview
● Healthcare spending
● Allocation of funds
● Patient journey
● Hospitals
Key Opportunities ● Long term care & retirement homes
● Home & community care
Approval Process ● Approval and procurement in Canada
Nordic-Canada Health ● Program background
● Details of program
Solutions Initiative ● Partners & facilitators #nordicsolutions
● Application process to global challenges
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2Hospital statistics (Ontario)
1M km2
Area of Ontario
Full capacity
Half of all hospitals were at full
capacity with some hospitals
under 20 to over 1,200 beds at 140% capacity (85%
Range in the amount of beds/hospital considered safe capacity)
141 206,000 17%
public hospitals total number of acute hospital beds occupied by
corporations Ontario hospital patients who should be receiving
(262 hospital sites) employees care at home, in long-term care or
in the community
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2Hospital spending
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2Hospital sector:
Opportunities & Feedback
Efficient workflow and better
Optimizing hospital facility
waiting times
Medication management Infection control
Patient safety Lowering readmission rates
Interconnectivity Data SecurityHospitals – things to consider
• Hospitals are allocated ‘global annual
budgets’ for providing services
• Budgets fluctuate based on population,
need and efficiency
• Priority within reducing costs, improving
quality and outcomes, and giving patient
empowerment
• Wide spread use of EMR
• Older hospitals face difficulty in utilizing
Wi-fi/bluetooth based technologies due to
infrastructure
• Green builds are proactively
implementing fully digitized facilities
• Many hospitals require pilot projects prior
to implementation – requires time,
resources and funding
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2Agenda
Healthcare in Canada ● Geographical overview
● Healthcare spending
● Allocation of funds
● Patient journey
● Hospitals
Key Opportunities ● Long term care & retirement homes
● Home & community care
Approval Process ● Approval and procurement in Canada
Nordic-Canada Health ● Program background
● Details of program
Solutions Initiative ● Partners & facilitators #nordicsolutions
● Application process to global challenges
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2Long term care and retirement home stats
45% 78,872 700 6.5 million
public-sector Beds for long- licensed retirement Nursing visits
health care dollars stay residents homes in Ontario
spent consumed
by seniors
27 million
78,872 hours of personal support
Staff and homemaking services
to more than 600,000
clients per year
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2Long term care & retirement homes:
Opportunities & Feedback
Efficient workflow Improve environment & experience
Improve e-connectivity Increase safety/health
Help plan & coordinate care Better manage food services
Human resources
18Long term care & retirement – things to consider
• Many long term care homes want to
pilot a new technology before
purchasing – costly and lengthy
• Public vs. private long term care
homes have different decision
makers and funders
• Safety and regulatory approvals can
be difficult to navigate and may be
lengthy processes
• Procurement rules and process may
differ between LHINs and long term
care homes
19Agenda
Healthcare in Canada ● Geographical overview
● Healthcare spending
● Allocation of funds
● Patient journey
● Hospitals
Key Opportunities ● Long term care & retirement homes
● Home & community care
Approval Process ● Approval and procurement in Canada
Nordic-Canada Health ● Program background
● Details of program
Solutions Initiative ● Partners & facilitators #nordicsolutions
● Application process to global challenges
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2Home & community care stats
73% increase
in home care funding in Ontario
(from 2005-2015)
20% more patients
have been receiving care at home
in the past 5 years
13% more patient referrals
from hospitals
Caring for terminally ill patients in an
acute-care hospital is estimated to cost
Image source: Global News
over 10 times more
than providing at-home care
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Opportunities & Feedback
Monitor and connect with
Efficient workflow
patients
Help patients self-manage their
Improve communication care
Physical & emotional security Reduce social isolationHome & community care – things to consider
• Ontario is made up of 14 different LHINs, each
with varying budgets and strategies – fragmented
province, subtle nuances between each LHIN
• Third party service providers (e.g. Saint
Elizabeth) are often technology users and
buyers, but not always (sometimes it is the
LHINs)
• Many LHINs and third party service providers will
require pilots in order to purchase new
technology – costly and lengthy
• Safety and regulatory approvals can be difficult
to navigate and may be lengthy processes
• Procurement process may be unclear between
LHIN and third party service provider
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2Agenda
Healthcare in Canada ● Geographical overview
● Healthcare spending
● Allocation of funds
● Patient journey
● Hospitals
Key Opportunities ● Long term care & retirement homes
● Home & community care
Approval Process ● Approval and procurement in Canada
Nordic-Canada Health ● Program background
● Details of program
Solutions Initiative ● Partners & facilitators #nordicsolutions
● Application process to global challenges
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2Approval process in Canada
Source: MaRS Discovery District
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2Procurement in Ontario
● Ontario spent C$12 billion in 2017 on procurement of healthcare
goods and services
● 70% of medtech purchases are done at a hospital
● Highly fragmented process of procurement
● Approvals, reimbursement codes, clinical trials do not guarantee
adoption
● Must demonstrate cost savings/budget impact
● Hospitals often have their own Value Analysis Committee to
determine economic benefit of technology
● Over C$100,000 must go through a transparent tender process
(RFI/RFP/RFQ) - can take 6 mos - 2 years
● Shared Services (SSO) for commodity purchases - but starting to
procure innovative technology as well
● Bundled payment pilots on some procedures may lead to the
procurement of novel technologies and across silos
● Procurement by co-design and issuing problem statements
increasing - more novel solutions being adopted
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2Agenda
Healthcare in Canada ● Geographical overview
● Healthcare spending
● Allocation of funds
● Patient journey
● Hospitals
Key Opportunities ● Long term care & retirement homes
● Home & community care
Approval Process ● Approval and procurement in Canada
Nordic-Canada Health ● Program background
● Details of program
Solutions Initiative ● Partners & facilitators #nordicsolutions
● Application process to global challenges
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2Why Canada is great for Nordic companies
Canadian Med Tech Advantages Benefits
• Government committed to • Stable, predictable market growth
healthcare funding
• Attractive for commercializing new devices
• A top 10 medical device market
• Ideal for high quality clinical trials
• High volume tertiary care hospitals
• Ability to track and evaluate outcomes
• Integrated healthcare delivery
• Less trial set up times and better product
• Highly trained clinicians design feedback
• Top scientific talent • Access to leading edge science
• Health technology assessment • Faster, more efficient reimbursement
strategies for Canadian and global markets
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2Why join?
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2Our Nordic-Canada Health Solutions Initiative offers
full year program for accelerated market entry
2018 2019 2020
Determining Eligibility: Visit 1 to Canada: End of Official Program:
* April 1-3
Held in Nordic cities and online Nov. 19-23
• Canadian market 101 • Canadian health system advanced training • Companies are in a position
education session • Breakout detailed education sessions and to independently test or pilot
(free for all interested site visits within specific sub-sectors (i.e. with Canadian organization;
digital health, devices, etc.)
companies) establish partnership/
• Advanced pitch session with local experts
distribution agreement, etc.
• Q&A session with • Presentations from and networking with
Canadian expert Nordic companies already established in
Canada
• Application process for
program participation
Follow-up meeting (online or in person):
Spring
deadline Dec. 21
• Go-to-market strategy review and pitch
revisions with Canadian experts
* all dates
subject to
Visit 2 to Canada:
Fall 2019
change
• Small group or 1:1 tailored meetings with
relevant stakeholders
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2Company application deadlines to join initiative
Task NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV
One day Introduction to Healthcare in
19-
Canada workshop with Canadian experts 23
( held in Nordic cities and online)
Deadline to submit application for
21
participation
Selection of 20 companies to join 14-
program and signed agreement 18
Week
Nordic Initiative Kickoff call with all of
participants 11
First tour to Canada 1-5
Second tour to Canada TBD
Company costs include: 50,000 NOK to participate in Nordic Initiative and any company travel involved in the program
To apply to join the Nordic-Canada Health Solutions Initiative please register at: https://goo.gl/forms/5kbW9r463k5SHE593
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2Facilitators of our Nordic initiative in Canada
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2Odd Arild Lehne, Norway Health Tech
+47 958 33 144
oal@norwayhealthtech.com
www.norwayhealthtech.com
Kerry Allerton, Ministry of Foreign Affairs of Denmark
Senior Advisor, Healthcare & Life Sciences
M. +1 647 631 6947
kerall@um.dk
http://um.dk/en/
Agata Leszkiewicz, Business Sweden
Project Manager
T. +1 416 640 7477, M. +1 647 638 1474
agata.leszkiewicz@business-sweden.se
www.business-sweden.se
Lori Woloshyn, Innovation Norway Toronto
Market Manager
T. +1 416 920 0434 x124, M. +1 416 271 7327
lori.woloshyn@innovationnorway.no
www.innovationnorway.no
Johanna Tarvainen-Lee, Business Finland
Sr. Consultant
M. +1 416 400 1792
johanna@merenbridge.com
www.businessfinland.com
#nordicsolutions
Andri Marteinsson, Promote Iceland to global challenges
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2Additional Slides - Innovation in Ontario
First province to have
Chief Innovation
Officer in Healthcare -
OCHIS
Dual report - Health
Minister and Innovation
Mandate: put $50 B
health systems to drive
wealth creation
http://ontario.ca/healthinnovation
OCHIS
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