by Maureen O’Neil, President, CFHI | 03 Jan, 2018
(This post is a modified version of a speech delivered at The Walrus Talks Health on November 28, 2017.)
Canadians love medicare too much… twice as much as hockey. Three times as much as the Queen. Tommy Douglas tops the charts as the greatest Canadian because of his conviction and political courage in removing income as a barrier to healthcare.
Canadians look south and heave a sigh of relief that we don’t have millions of our citizens with no healthcare coverage at all. Our love of medicare and its status as an icon in our national mythology is a barrier to making necessary improvements.
This exalted status has frozen in time how we organize services, who actually provides care and which services are covered. Compared to other developed countries our healthcare system is ranked close to the bottom – and right at the bottom in
the time it takes to get an appointment with a specialist.
Why is it so hard to change?
Let us step back to the late 1950s when the Co-operative Commonwealth Federation (CCF) government lead by Tommy Douglas was designing a new health system. Saskatchewan wanted good connections between general practitioners (GPs) and specialists, with public
health and social services. There was even talk of community boards to ensure patient and community feedback. Unfortunately, an election was coming. Tommy Douglas’s Cabinet was worried that this fundamental reform would be lost if they tried
to sell a whole new approach. Instead, Cabinet agreed government would insure everyone so that people didn’t have to pay for doctors’ visits. (Tommy Douglas’ government had already insured hospital care in 1947.) Left aside was the
dream of creating an unbroken continuum of care. They settled for a payment system, not the well-connected health system they wanted. Although peoples’ incomes were no longer a barrier to doctors’ care, there was no coverage of dentists,
physiotherapists, psychologists, or drugs.
When the federal government brought in medicare in 1966, all provinces eventually adopted the Saskatchewan compromise. Private insurance through employers, particularly large employers, looked after care not covered by medicare. Unfortunately, at least
30% of Canadians didn’t and don’t have those benefits. They must pay for these health services and drugs – not much different from America. However, it is much different from European countries. This is one of the main reasons we
fare badly in international comparisons.
It isn’t efficient or even the most appropriate care to have only hospitals and doctors’ visits fully funded. It is inefficient not to cover drugs; to have patchy access to affordable home care and nursing homes; to make it hard for people
to see a psychologist or a physiotherapist. It is definitely not good care when people with mental health or addiction problems have to wait months for treatment unless there is a dramatic crisis.
It is possible, indeed probable, that because medicare is our number one love, tampering with it exacts a huge price. Most governments are reticent about saying to their citizens that we have problems, that we could do much better, that there is lots
of room for innovation and improvement. Staying the same, with nearly 40% of every province’s program budget spent on healthcare means we will be starving income support, education, housing, social services – the very kinds of supports
that are important for good health. Curiously, there is little discussion of why our healthcare is less safe, say, than the Dutch.
Provinces have tried to improve healthcare by creating regional management structures (like the Local Health Integration Networks in Ontario), through various financial incentive payments to doctors, joining with the Canadian Institutes for Health Research
in supporting patient oriented research.
We have had limited success in improving performance. We are still near the bottom of the charts.
The technology revolution has huge potential to give more control to us – as citizens and patients – to manage our own health. Is anybody here becoming an obsessive step counter? The sky is almost the limit. We see it in action in post
operative follow up as the Ottawa Heart Institute has been doing; but email appointments with your family physician? Not usually. Any innovation you can think of is happening somewhere in the world. We need to bring them home to Canada, try them out
here, create our own, and change regulations to accommodate them if we have to. Both the Champlain BASE™ eConsult Service (BASE™) and
the Rapid Access to Consultative Expertise (RACE™)—two
leading Canadian innovations--dramatically speed family doctors’ access to specialists’ advice. Patients don’t have to wait months to see a specialist because in all but about 30-40% of cases the GP can handle it. This will be especially
helpful to people in rural and remote parts of the country. CFHI helps hospitals and healthcare organizations incubate, spread and scale better ways of providing care. We work with the innovative doctors, nurses and administrators, for example, to
reduce inappropriately prescribed antipsychotics to people with dementia in nursing homes, to provide care at home for people with advanced chronic obstructive pulmonary disease, to share innovations like Dr. Liddy and Dr. Keely’s. The results?
Better care which costs less than the status quo.
What do I recommend for our much-loved but underperforming medicare?
Make it easy for one province to learn from another. Support through regular health budgets the best local ideas of doctors, nurses and other care providers to encourage positive change.
Put expanding coverage of health services on the agenda.
Dare to experiment with both private and public, for-profit and not-for-profit providers as long as patients’ income doesn’t determine access.
Put patients and their families at the centre.
Which brings it back to us. No more unconditional love. We should have the quality of care that Tommy Douglas fought for. After almost 60 years, isn’t it time?
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