A good starting point for any discussion – especially as the leading edge of our baby-boomers have now turned 65 – can be found in an overlooked recommendation in the Romanow Report (#5) tabled in 2002. It suggested both that the Canada Health Act be modernized and strengthened in order to reinforce the principles of public administration, universality and accessibility, and that we update the comprehensiveness of our health system and create a new principle of accountability.
The recommendation is breath-taking in its scope – all the more since it is still relevant in 2015. Sadly, little if any, progress has been made in the intervening 12 plus years – and certainly not in the area of accountability, a sticking point for many Canadians.
Some of the key issues in healthcare that require attention during the election campaign include:
- clearing up healthcare transfer payment details to the provinces and territories;
- setting clear goals and objectives for provinces and territories to “buy change” in delivery models that measure health outcomes of interventions, and ensuring that these interventions reflect best practices;
- defining where responsibility for the enforcement of the Canada Health Act lies;
- understanding the impact trade agreements may have on the future of medicare, and finally;
- discussing the feasibility of creating and implementing a national pharmacare program.
All of these issues, unfortunately, have been largely ignored by the current federal government, if not by the general public.
Providing solutions to these issues is the task of those who seek to represent us in Parliament; seeking answers to these and other questions is the responsibility of concerned citizens.
From my direct experience as a physician and as a patient, medicare generally delivers on its promise of providing care for all in a timely and effective fashion. Unfortunately wait times for total joint replacements are now rising in some jurisdictions. While the principles of universality, comprehensiveness, accessibility, portability and public administration continue to resonate with Canadians, we must maintain a constant vigilance of medicare’s performance.
Where do we go from here?
While many progressive options are possible, one choice with potential for high impact and a prospect of an enormous return on savings merits our attention: the adoption of best practices across provinces and territories.
In 2010, the Organization of Economic and Cooperative Development (OECD) estimated that, on average, member states could save 2 per cent of their GDP by 2017 with the adoption of best practices in their healthcare systems, pegging Canada’s saving at 2.3 per cent. Given that Canada’s GDP is approximately $1.825 billion, this suggests the possibility of a savings of over $40 billion ($41.975) annually.
But what does it mean to adopt best practices?
Simply put, success stories evaluated in healthcare delivery across Canada reveal “nuggets” of best practices in almost every jurisdiction. One example is the Alberta Bone and Joint Healthcare Institute, which has revolutionized musculoskeletal care including hip and knee replacement, reduced wait times, shortened hospital stays and increased satisfaction of patients all in a cost-effective manner.
Another example is the practice of Patient Centred Care in the primary healthcare setting, which is based on care, communication and common ground and treatment based on the best available evidence that patient and provider agree upon. This approach has been shown to reduce unnecessary tests, decrease the number of physician visits needed and provides higher satisfaction and better outcomes in the management of chronic conditions such as hypertension.
For a healthcare system to continue to serve Canadians into the future, continued vigilance and progressive change with cost constraint must be attractive to policy and decision makers. Now it’s time we heard what our political parties plan to do for medicare.
Robert McMurtry is an active orthopedist and formerly Dean of Medicine at Western University and Assistant Deputy Minister of Health Canada. He was a special medical advisor to the Royal Commission of the Future of Health Care in Canada (Romanow Commission).