An independent review panel has published a report with 76 recommendations for improving the Yukon’s health system, which it found to be fragmented and lacking a long-term public health lens.

“I think a lot of the problems are from the fact that there’s been a siloed nature of the health and social system,” Bruce McLennan, the chair of the Independent Expert Panel, said during a media briefing on Wednesday afternoon.

“Everybody has the best intentions of giving the best delivery of service to clients, but there’s a strong sense that a lot of the organizations are operating in isolation from one another .… There’s not an overarching vision, which really is missing in this system.”

The panel, consisting of five experts in health and public policy, was established by the Yukon government in 2018. It released its final report, “Putting People First”, on Wednesday afternoon.

The panel spent a year and a half reviewing the territory’s health and social services programming.

It found that:

• many aspects of the system are not communicating with each other;

• there are insufficient supports for seniors, people with disabilities and low incomes;

• many Yukoners do not have access to a primary care provider; and

• many First Nations people have experienced racism in the health system.

The 207-page report includes sweeping recommendations for a whole-system overhaul, which the panel says will address the base issues in providing care.

“We decided that it was far better to get to the root of what was causing gaps in care and provide recommendations that would fix these problems,” the report says.

“This means that many of our recommendations require some front-end investment.”

The report has a “quadruple aim” of improving patient and health care provider experiences, managing costs and improving overall health outcomes.

During Wednesday’s media briefing, McLennan said 30-40 per cent of the recommendations could be implemented fairly quickly, while the others will take more time.

The report calls for a new organization, Wellness Yukon, to be launched. Wellness Yukon would manage the redesigned care system the report is calling for.

Wellness Yukon would take over primary care, broadly defined as hospital care, long-term care, home and community care, medical evacuation and disease management.

It would also be responsible for measuring and evaluating outcomes, satisfaction, quality and costs of service.

Wellness Yukon would also manage the hospitals currently under the Yukon Hospital Corp.

The report found that there are currently several barriers to receiving consistent medical care in the Yukon.

It found that 27.2 per cent of visits to Whitehorse’s emergency department were for conditions that could be managed in a primary care setting, like a doctor’s office.

This is because 21 per cent of Yukoners don’t have a family doctor, the report found. Those who do have a physician told the panel they struggle to obtain same-day appointments with their provider, turning to emergency services instead.

Public engagement with Yukoners found that travelling to a care provider in Whitehorse is a barrier to receiving medical treatment.

This is, in part, because the Yukon government’s $75 per day medical travel subsidy is insufficient for covering travel costs.

The report says Yukoners may experience worsening health conditions over time, because they do not have access to treatment due to travel or lack of a care provider.

To combat this problem, the report calls for a new model of care, in which every Yukoner is matched with a primary care provider, as close to home as possible.

This requires the establishment of primary care teams, which would each be responsible for the care of 1,200 to 1,400 Yukoners.

The care teams would operate through community health centres and wellness hubs. Each care team would include a primary care provider, a nurse who also acts as a case manager, a medical assistant and administrative support workers.

These teams will have access to a broader network of specialists, including pharmacists, dietitians, midwives, mental health resources, and more.

“This marks a pretty big departure from the system,” panel member Gregory Marchildon said Wednesday.

“We do not have that kind of continuity and co-ordination that you could have through this new system.”

The report also calls for the medical travel subsidy to be doubled, from $75 per day to $150 per day.

It also makes several recommendations for advancing reconciliation.

It found that many First Nations people experience racism while seeking care. They leave the system feeling disrespected, unheard and that their traditional knowledge and healing were not understood.

The report conceded that significant efforts have been made to prioritize hiring staff of First Nations ancestry in some areas of the health and social services system.

There is still much work to be done, however, and the report calls for an overhaul of the health system to be culturally safe for First Nations Yukoners.

It calls for increased partnership with Yukon First Nations to develop a co-ordinated approach to increasing cultural safety.

This includes enhancing First Nations programming in long-term care, increasing access to land-based healing and establishing a system that understands the factors affecting the health of Indigenous people.

According to McLennan, the lack of cultural safety has deep roots in the health system.

“I think it’s really part symptomatic of a larger systemic problem with the overall stewardship,” McLennan said.

“There has always been a relationship with First Nations but I’m not sure it always worked.”

He added that these systemic issues affect First Nations people across the country.

“When I think about our system we have now, it is very much of a Western mind of thinking, so we want to go into a more holistic approach.”

The report also makes recommendations for fostering community wellness and better involving community members in assessing their individual needs.

This includes working toward fully-funded, universal early childhood education.

There are also recommendations for ensuring financial sustainability.

The report found that the Yukon currently spends $8,000 per person on health every year, which is well above the national average. This, however, does not result in more effective care.

The panel suggests that the territory spends too much money on hospitals, long-term care and shelters and fee-for-service payments to physicians.

The Yukon government would be better off redirecting spending to prevention and the root causes of medical issues, the report says.

“Not only is the current system financially unsustainable, we heard loudly and often from Yukoners across the territory … that the current system is not meeting their expectations and needs to change,” the report says.