An editorial in the Nov. 1 issue of the Canadian Medical Association Journal recognizes, as have the Quebec courts, that Canadian health care violates human rights when governments cause limited or delayed access to primary and specialist care.
In Nova Scotia, medicare is evolving into a system of haves and have nots because policies of the Nova Scotia Health Authority limit the availability of family doctors and specialists.
For seniors, who have had the same doctor for many years, the problem is aggravated because these patients have increasing difficulty finding a doctor to replace physicians who are retiring.
Canadians strongly endorse the commitment made by Tommy Douglas, a founder of medicare, when he said “people should be able to get whatever health services they require irrespective of their individual capacity to pay.”
Most Canadians applaud the principles of the Canada Health Act that suggest all of us should have access to the comprehensive care we need.
The fifth principle of the Canada Health Act, public administration, implies that government should be a facilitator, not a barrier to excellent care.
However, in Nova Scotia, public administration has become the barrier preventing communities, patients and medical clinics from hiring the people they need to provide timely care.
Usually, governments regulate and evaluate services. The public administration clause of the Canada Health Act puts government into the uncomfortable position of having to regulate and evaluate services that government administers.
In Nova Scotia, the insurers and administrators of care would be punished if there were an independent regulator, because many people can’t get a family doctor, waiting times in emergency departments are excessive and waits for necessary surgery cause prolonged and unnecessary discomfort.
The Nova Scotia Health Authority is preventing clinics and communities from hiring the doctors they need. The result is three tiers of government-sponsored primary care.
People in the first tier, a small number, have government-funded access to care 24 hours a day, with a doctor or team of clinicians who see them in person or communicate by telephone or email.
A few other Nova Scotians also have first-tier access to around-the-clock care, but must pay privately for better access.
People in the second tier have government-funded access, mostly during the day, to a personal physician and after hours must rely on an impersonal 811 telephone service, walk-in clinics and emergency departments.
The 80,000 people in the third tier don’t have a family doctor and must rely on walk-in clinics, the 811 telephone service and emergency departments for primary care.
Rather than encouraging increased access to primary care, the Nova Scotia Health Authority is using the principle of public administration to promote rationing. Clinics and communities can’t hire doctors to meet the needs of the 80,000 citizens who don’t have access.
Perhaps the time has come to end government’s conflict of interest by removing the barrier – public administration – that prevents clinics and communities from hiring the doctors they need.
It’s time to do away with the unhealthy inequity in the delivery of health care. Let governments provide health insurance so rich and poor alike have access to the care they need. Then let communities and accountable community-organized co-operatives and community-appointed boards govern and administer care.
Dr. David Zitner, a family doctor, is Director of Medical Informatics at Dalhousie Medical School and a senior fellow at the Atlantic Institute for Market Studies.