GuelphToday received the following Letter to the Editor in response to an earlier Article posted on GuelphToday: With health care system 'near collapse,' MPP calls for action:
As I read the headlines about our healthcare system I wonder how a simple causal connection between access and financial input seems to be the only answer to ‘fixing’ a system that is complex, fluid and requires constant vigilance. To paraphrase Mike Schreiner’s words, ‘we really need to understand the context’, and the best starting place to accomplish that is to revisit Canada’s Health Care Act.
The Act was initiated Provincially in Saskatchewan and Alberta (1947 and 1950). In 1957 the Federal Government expanded on those beginnings with the Hospital Insurance and Diagnostic Services Act which was adopted by all the Provinces and Territories in 1961 and expanded to the Universal Health Care Act in 1966. The introduction of the current Canada Health Act (1984) is built on five Principles; non profit (publicly administered), comprehensive (medically necessary care), universal (health care for all), portability (out of Province/country), accessibility (equitable access). However, while the Act is enshrined in Federal Law, it is administered by the Provinces and Territories which leads to inconsistencies in the application of the five principles across Canada.
Challenges to health care prior to the covid pandemic included long waits for elected surgeries, overwhelmed emergency facilities, fatigued staff, and lack of available beds. These challenges surged over the course of the pandemic and are now magnified as the health care system plays ‘catch-up’ while simultaneously struggling with increasing omicron cases. The answer to mitigating these challenges does not lie only in increased public spending but better management of the funds available.
The Royal Commission on the Future of Health Care in Canada reported that the rising income of physicians could threaten efforts to contain health care costs (2002). Eleven years later two economists (H. Grant and J. Hurley) reported that between 2001 and 2010 net real annual physician income in Canada increased from $187,134 to $248,113 while more recent figures cite the average annual physician salary at $339,00 (Canadian Institute for Health Information-CIHI 2018). Close to 50% of the total health budget is spent on hospitals and physicians’ salaries (28.3%, 15.1%). All other health care services, including nurses and public health make do with what is left. Voices of dissent pertaining to physicians’ salaries were raised in 2018 when hundreds of doctors, residents and medical students protested their pay raises pointing out that nurses and other health care providers struggled with difficult working conditions, and patients with lack of access to services, while ‘the only thing that seems to be immune to the cuts is our remuneration’.
Recent statistics cite Canadians as having a whopping 31% in private insurance, the second highest among six developed countries including France, Germany, Sweden, Netherlands, the UK, New Zealand (CIHI 2017). The increasing incursion of the private sector in Government
services for the public, reveals the fragmenting nature of Canadian health care and results in costs passed on to beneficiaries, many who do not have private insurance leading to an inequitable two tier system between the ‘haves’ and ‘have nots’.
As the Provinces and Territories lobby the Federal Government to increase health care budgets, history has proven that this band-aid solution does not solve the chronic burgeoning debt nor does it meet the deeper challenges present in our fragmenting health care system. The complexity of health care does not make adhering to the five principles an easy task, but the first step is to recognize that throwing more money at the problem has not lead to a sustainable solution in the past and is unlikely to do so in the future. The harder task is to re-visit the way that the health care budget is managed and many health care economists are up to the task. Unfortunately, successive Governments appear unwilling to take the hard steps needed to reallocate resources to achieve a fairer, equitable, and more efficient system.
Strategies to mitigate the current challenges and provide more humane and efficient care, include more community health clinics that are fully staffed by nurses, physicians and other allied health professionals on a 24/7 basis. This would relieve the pressure on emergency rooms with astronomical savings to the public purse. The majority of those who wait to receive services in overcrowded emergency rooms could be treated in community health clinics. Impressive outcomes of this strategy have shown to benefit both the beneficiary and the budget with fewer hospital emergency trips, admissions and shorter lengths of stay when admission is needed.
Nurse Practitioners (NP) can carry out a large part of what a general practice physician would do in a primary health care/community context. NPs have the knowledge to diagnose and treat various mental and physical health ailments, order diagnostic tests, and know when to refer to a specialist or a hospital. NP clinics across Canada have shown sizeable savings to the public purse but many more are needed to relieve the pressure on emergency room and hospital physicians which would translate into budgetary savings.
Midwifery is an allied health professional group that can carry out routine deliveries safely. Midwives are knowledgeable about recognizing complications during the pregnancy or at birth and do not hesitate to call in an obstetrician for potential and/or real complications. Midwifery was introduced in Canada through legislation in the 1990s to an outcry from obstetricians and physicians however, the profession has managed to survive and although growth has been slow, midwifery provides budgetary savings.
The population/public health mandate is to improve the health of Canadians through interventions based primarily on disease prevention, health promotion and protection. The focus is on factors that influence health over the life course and identification of patterns of disease occurrence including outbreaks, epidemics, and pandemics yet historically, this valuable contribution receives short shrift with the largest amount of funding still going to ‘sick care’ rather than prevention. Re integrating the mandated services that have experienced drastic cuts in recent years, with a focus on strategies to maintain health, would translate into savings and a healthier population.
Keeping people at home with support has proven to be not only a cost saving measure but a humane one for elders and the physically/mentally challenged, who do poorly when hospitalized. However, more needs to be done to compensate Personal Support Workers (PSWs) to carry out this role. Unfortunately, for-profit agencies and/or public-private partnerships contract out these valuable health care providers at great profit, but at less than fair salaries and poor working conditions. The result is a constant shortage of staff impacting on quality of care and putting beneficiaries at risk of poorer health.
Questions pertaining to the gaps in our health care system that negatively affect equity and quality of care for those who contribute to the public purse through taxes remain, as Canada’s ‘universal’ health care appears to be coming apart at the seams. The lofty principles of the Canada Health Act are what most Canadians want to maintain however, to do so is going to take a lot of courage on the part of Federal and Provincial Governments and other stakeholders, to manage public funds more effectively, while following the Canada Health Act principles without exception. This is what was promised to Canadians, this is what Canadians pay for and this is what Canadians have a right to expect.