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December 11, 2011

A future for health care

The Canadian Charger

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Health is not just a medical issue. There are social determinants of health, and one of the keys is income distribution, poverty if you will.

At a public forum in Ottawa sponsored by the Canadian Health Coalition, two of the speakers, Natalie Mehra, Director of the Ontario Health Coalition, and Dr. Michael Rachlis, a distinguished health policy analyst, both made specific comment about the link to incomes.  Rachlis noted that the Occupy movement is addressing the issue and that Bank of Canada Governor Mark Carney sided with the Occupiers on that concern.  When asked by the Charger about welfare rates, he replied, “They’re disgusting.”

Can we afford health care?  We hear all the dire warnings that health care is about to eat up entire provincial budgets.  However, Mehra pointed out that across the country there has been an orgy of tax cuts. “If we give away the entire budget, of course it will take 80% of the budget.”  That is the figure some prognosticators predict will come into play in a few decades.

Allan Maslove, Carleton University’s Director of the School of Public Policy and Administration, noted that looking at the issue in terms of percentage of GDP (gross domestic product) health spending is relatively stable at 10 to 12%.  The pressures increasing health spending such as new technologies and aging population, amount to .8 to .9% a year.  “The cry that the sky is falling is meant to scare people and it seems to be having some success,” he commented. 

However, one area where costs are rising rapidly is in drug costs.  John Abbott, CEO of the Health Council of Canada, noted approvingly Ontario Minister of Health Deb Matthews going head to head with the pharmacies on the cost of generic drugs, and not backing down.

Participants on the panel addressed the issue of privatization. They pointed out that it does not save money. It simply shifts the costs from the public sphere to the individual user.  And evidence shows, said Diana Gibson of the Parkland Institute, that the costs are greater in private provision, while quality is poorer.  But should the determinant be ability to pay?  Roy Romanow, who headed the Royal Commission on the Future of Health Care in Canada, declared at the meeting that health care is “the right of the citizen, not the privilege of status and wealth.” 

Wait times are a major concern for consumers of health care. There has been little change since the 2004 health accords between the feds and the provinces when five areas were specified for attention.  Romanow, who proposed these priorities, now admits that “It was a mistake.” 

Rachlis argued that rationalization of health care is the major challenge.  Rather than focusing on individual medical practitioners we should emphasize movement to multi-service community health centres. He gave as an example of rationalization the restructuring of mental health services in Hamilton, in which wait times were eliminated.  The psychiatrists developed a rapid service model, largely based on using social workers to provide care.

Abbott proposed that Canada set one health goal a year for the next ten years, for example, the health of Aboriginals, seniors, the poor.  Marc-André Gagnon, an Assistant Professor in Maslove’s faculty, pressed the importance of pharmacare, perhaps another item for Abbott’s list. 

Romanow set forth five principles to follow in medicare reform:

1.  Go with a universal single payer system.  It is cheaper.

2.  Keep the focus on total costs, not just costs to the public system.

3.  Address the issue of wait times.  To do this, invest in information technology and health care integration.

4.  Address determinants of health–adequate income, housing, good education, etc.

5.  Governments must show will and determination to transform health care, eliminating silos.  Home care needs to be integrated into the system on a national basis.  Community health centres are a way of curtailing medical silos.

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