How can we ensure sustainable funding for our Medical Centre?

INTRODUCTION TO A FACT SHEET SERIES

By the Saturna Sustainable Health Funding Committee  

There is a growing concern about the future of health services on Saturna, and in particular about the Medical Clinic and the funding that supports it. The Saturna community needs to address this issue so that we can proceed into the future assured that our Medical Clinic will be there when we need it.

A group of individuals and representatives of island organizations came together in November 2016 over a collective concern about the sustainability of funding for the Medical Clinic. The group, which calls itself the Saturna Sustainable Health Funding Committee, began exploring ways to ensure more stable funding for health service delivery on Saturna well into the future.

As context for its work, the group reviewed the array of health and well-being services offered on Saturna, with a focus on those available through the Medical Clinic. The out-of-clinic services, which complement and augment those offered from the Medical Clinic itself, range from Better at Home (a support program for seniors) and public access defibrillators to an annual flu clinic, and Saturna Island Rescue, which provides 24/7 emergency response.

After considerable research and discussion, the Committee is in a position to commence a discussion on the future of health services on Saturna with island residents. And so, to kick-start the conversation, the Committee has developed a series of Fact Sheets to share the information it has gathered and the preliminary conclusions it has reached with the broader Saturna community. The intent is to provide Saturna residents with baseline knowledge, making future consultation more focused and productive. The Fact Sheet series, thus far, includes:

Fact Sheet #1: About the Saturna Medical Clinic
Fact Sheet #2: The Need to Sustain Funding for the Medical Clinic
Fact Sheet #3: Options to Sustain Medical Clinic Funding
Fact Sheet #4: Health Services on Other Gulf Islands 
 

Saturnacan.net is happy to reprint them below. Please read these Fact Sheets to have the full story, then come to the Community Meeting on Oct. 7. 2017 from 1:30pm to 3:30 pm at the Community Hall and join in the discussion.

FACT SHEET #1: ABOUT THE SATURNA MEDICAL CLINIC

A. Services Offered:

• one day per week a General Practitioner (MD) - 4.5 hrs.
• one day per week a Nurse Practitioner (NP) - 4.5 hrs.
• twice monthly a counsellor and a home care nurse
• medical equipment loan cupboard
• referrals management
• co-ordination of a prescription pick-up service
• issuance of TAP travel passes to get to off-island tests or referrals
• hearing clinic.

B. Clinic Use: 900 appointments annually, plus occasional use by Saturna Island Rescue (the volunteer ambulance service).

C. Benefits Provided:

  1. Reduces the number of trips off island for medical appointments, making island living easier for those having difficulty getting off island, including working people, young families and the elderly.
  2. Contributes to the vitality and attractiveness of our community by providing services, island employment, and local control.

D. Clinic Management and Cost

The Saturna Medical Clinic has been managed and operated for many years by the Saturna Community Club, through its volunteer Health Services Committee.

With no resident medical practice on Saturna Island, the Island Health Authority (IHA) pays a day fee and travel costs to the MD, pays the Nurse Practitioner who comes from away, and provides drugs and some medical equipment to the clinic.

IHA also provides, through the Community Club, a part of the salary for a Medical Office Assistant (MOA) who is employed by the Community Club to assist the visiting practitioners, and a 4 hours per month salary for medical supply restocking labour.

The Community Club’s total annual budget for clinic operations, including the total MOA livable wage salary for health practitioner days and restocking work, non-medical supplies, and cleaning and utilities has been about $23,600 for the past couple of years. 

FACT SHEET #2: THE NEED TO SUSTAIN FUNDING FOR THE MEDICAL CLINIC

For decades, the Saturna Community Club has managed the Medical Clinic on an all-volunteer basis, through its Health Services Committee. Over the years, the amount of funding required to maintain the clinic has been growing. Last year’s operating budget (not including Medical Doctor and Nurse Practitioner contract fees, drugs or medical equipment, provided by IHA) was $23,600.

A. Current Sources of Support for the Clinic:

  • Island Health Authority: MD and NP fees, medical supplies, and for clinic operation, partial funding of the Medical Office Assistant, and funding for restocking labour.
  • Rental Income from other health care professionals is minimal (currently a massage therapist.)
  • Clinic Patient Fees (for services not covered by MSP) are minimal, and vary from year to year.
  • Donations have primarily been from the Annual Garage Sale conducted by the Saturna

    Recycling Centre, and gifted to the Medical Clinic. After 2019, when recycling’s confirmed

    funding ends, the Recycling Centre may need these funds.

The Saturna Community Club has always covered the annual shortfall, and provides the volunteer labour to manage the clinic. Should alternative funding for the Medical Clinic be secured, the Community Club will continue to provide support for health services on Saturna Island.

B. The Current Situation:

The Community Club’s only source of funds is the annual Saturna Lamb BBQ on Canada Day. These funds must maintain and insure the Community Hall and Recycling Centre, as well as keep the Medical Clinic clean and supplied, utilities paid, and the Medical Office Assistant’s wages topped up to a liveable level.

C. Our Concerns:

  • The BBQ’s viability is uncertain as volunteers age and burn out (average age on Saturna is 60).
  • ​The BBQ’s revenue is inconsistent, and could be greatly curtailed by bad weather and other factors beyond the island’s control.

D. Opportunities:

  • Secure,stable, funding will allow the creation of a paid part-time Health Co-ordinator position and a bookkeeper which would take stress off aging clinic volunteers.
  • Alternative funding for the Medical Clinic would free up BBQ revenue for supplementary health and wellness services not currently possible, but available on other islands. 

 FACT SHEET #3: OPTIONS TO SUSTAIN MEDICAL CLINIC FUNDING

There are several scenarios currently under review to address the sustainability of Medical Clinic funding. There is no necessity to select only one of the avenues - we may consider the use of one or more of the options in concert.

The first task was to review, in detail, the current budget, both the expenditures and the sources of income. The second task was to look at our needs for the future of the operation and to propose an expenditure budget that meets those needs. This may include, but is not limited to, the addition of a part time clinic manager, bookkeeper and/or other new services. These reviews give us the gross amount of income necessary, on an annual basis, to provide Saturna residents, weekenders and visitors with adequate service.

The next step was to take a serious look at the current sources of income and determine the stability and level of risk for each into the future. This allows us to fully understand the gap between proposed expenditures and secure revenue available.

While the committee was dealing with the gap issue, the possibility of securing or increasing the current cash inputs was studied. Options discussed include:

• long-term secure income from the Saturna Community Club
• increased clinic rentals to other health professionals
• donations from service groups or island organizations
• annual revenue from the Saturnina Foundation or other long-term endowment fund
• a tax levy
• the status quo.

After intense study we believe that we may need to look at a portion of the financial needs being met by a property tax that could be put in place with a referendum during the 2018 municipal elections. This would be the foundation for stable funding. The CRD would oversee the referendum, giving every property owner on our island a voice on proceeding with a tax levy for the clinic. A simple majority vote would decide the issue.

The exact amount of annual tax on your property has not as yet been calculated, but would likely fall within the range of $7 to $15 per $100,000 of value for a residential property.

It is time for discussion and expanded idea gathering. Your input is requested. 

FACT SHEET #4 - HEALTH SERVICES ON OTHER GULF ISLANDS

No two places are the same in providing health services. Each island has varied funding: doctors' fees, taxes, rent, donations and volunteer labour. Differences in size, location, population and services offered are key factors. The Rural Health Services Framework document created by Island Health (IHA) classifies Saturna as an “Isolated Island”. The classification of each place sets a framework, but doesn’t determine what services can or could be provided. It is however useful to compare and contrast Saturna to other similar Gulf Islands or “isolated islands”.

Mayne Island has a population three times larger with more frequent ferry service, yet shares characteristics with Saturna. The Mayne Island Health Centre Association (www.mayneislandhealth.ca/), a BC non-profit society with a board of directors, operates the health centre. It is funded from property taxes (collected through the Mayne Island Improvement District), donations, rent and events. Services available include;

  • Resident Physician 3 days per week (fee for service and IHA 'top-up')
  • Nurse Practitioner 3 days per week (IHA)
  • Massage, Chiropractic (private)
  • Home and Community Support (IHA)
  • Mental Health and Substance Abuse (IHA)
  • Vision care (Private)

Galiano Island has both a similar population and ferry frequency as Mayne. Galiano Health Care Society (GHCS), a registered BC non-profit and a federal charity, has provided health services on Galiano for the past 25 years. It operates the GHC Centre through a board of directors and an executive director and staff. Their total annual budget is approximately $ 140,000, funded by events, donations, grants, rentals and an annual property tax levy (since 2014). In 2014, the GHCS applied to the CRD to place $86,500 per year on the property tax rolls (of which the CRD receives a $1,550 administration fee). This passed with 90% support. Services at the Health Centre include:

  • Full time Doctor, Nurse Practitioner, and Home and Community Care Nurse (IHA)
  • Once a week dentist
  • Better at Home, Ageing in Place, Education
  • Physiotherapy, Podiatry, Massage, Laboratory

With a population of 2,300, and very frequent and convenient ferry service, the Pender Islands have resident physician(s) who operate the clinic on a fee-for-service basis typical of larger communities, avoiding the necessity of community funding. They also offer a wider range of services that can be supported by a large population.

Hornby Island is quite isolated, with a population of about 1,000 residents and infrequent ferry service. It operates in alliance with adjacent Denman Island (population of 1,100) and the Comox Valley, in one large and well-funded entity (from taxes, donations, doctor’s fees, fund raising, etc.) with several clinics. It has resident doctors, paid administrators and a wide range of services. Unusually, they charge a membership fee of $5.00 per year. 

Community Meeting - The Future of the Saturna Medical Clinic

Saturday, October 7, 2017 - 1:30pm to 3:30pm at the Community Hall

There is a growing concern about the future of health services on Saturna and in particular about he Medical Clinic and the funding that supports it. The Saturna community needs to address this issue so that we can proceed into the future assured that our Medical Clinic will be there when we need it. Please attend.

 

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