A Medicare@50 blog post by:
Farah Shroff, Associate Professor
UBC School of Population and Public Health
Besides hockey, few things are so quintessentially Canadian as Medicare. Many a Canadian has been known to say, “Being Canadian is to have universal coverage of medical care.” So it is with great pride that most of us celebrate Medicare’s 50th anniversary this year. I am very excited to be one of the speakers at Medicare@50: Our Healthy Future and the Roles of Community Health Centres, a conference taking place September 25-27 in Saskatchewan, the birthplace of Medicare.
It was a long and arduous effort to bring essential medical care to all Canadians in 1963. Prior to the implementation of Medicare, those without ability to pay suffered from easily treatable conditions. Some died for lack of life-saving care. While some features such as geography still hamper ease of access to care, financial barriers have largely been removed from the equation.
Social justice issues are paramount in the discussion of universally accessible medical care. Canadians of all religions, ethno-cultural groups, genders, ages, illness statuses, and so forth are eligible to receive care. The Canada Health Act enshrined this in legislation, guaranteeing five principles:
- Accessibility: all insured people are assured reasonable access to medical services.
- Universality: all insured Canadians are assured the same level of medical care.
- Public accountability: administration of health care is carried out on a non-profit basis by a public body.
- Portability: Canadians may move from one part of the country to the other and receive the same standard of medical care.
- Comprehensiveness: all medically necessary services are insured.
While there have been challenges, Medicare remains intact today. Unfortunately we are paying approximately $200 billion a year for this program, and costs continue to spiral. If we are unable to curb these burgeoning costs, we are going to lose Medicare.
The system requires innovation and transformation. Working as a consultant for the Institute for Health System Transformation & Sustainability, I wrote a paper for British Columbia’s health care leaders — “Innovation and Transformation in Health Systems: A Primer for the BC Health Authorities’ Leadership Council” — that states:
“Transformation is a change in form, appearance, nature, or character. It is a foundational alteration in the way in which health systems are conceptualized, designed and do business. Innovation is a catalyst for transformation. Literature on the implementation of large‐scale system change offers a few theoretical and practical guides for such overhaul; the Consolidated Framework for Implementation Research (CFIR) and the Tyler Collaboration model are a couple of these which have been tested in the health sector.”
The need to redesign the health system
The Canadian health system is unsustainable financially and otherwise; costs continue to increase, and continuing “business as usual” will not meet growing demand. Canadian governments currently spend $200 billion a year nationally; most provincial governments spend half of their budgets on health systems. Health system costs outdistance the growth of Canada’s GDP, while demand continues to grow, partly due to increased rates of chronic conditions. Most of our system is based on short‐term, acute, episodic care—not adapted to the current reality of long-term health problems that require more education, promotion, and disease prevention. Self‐management, peer‐to‐peer support, and group‐based courses on chronic conditions, proven to improve outcomes and save costs, are a small feature of the health services landscape.
On the whole, patients report satisfaction with hospital care, and it seems to function relatively well for acute problems. On the other hand, patient safety is a serious concern, specifically in our hospitals. Costs continue to spiral, partially as the price of patented pharmaceuticals take a greater share of the pie; physician and surgeon services are the greatest single cost to the system. Primary care is in crisis; while Community Health Centres, nurse practitioners, and other viable solutions exist, political quagmires have prevented them from proliferating.
Canada ranks near the bottom of OECD (Organization of Economic Cooperation and Development) nations in terms of quality of our health system and its outcomes. Finally, reducing and eliminating social and economic inequities will make a significant impact on health outcomes. Redesigning health care systems—the focus here—would also improve health outcomes.
Transformations should produce better health and better care at better value, so they improve health status, improve quality and decrease cost. They ought to create evidence‐based, patient-centred collaborative, integrated care systems.
Farah Shroff, Ph.D., is Director of the Adler School’s M.A. in Community Psychology program at its Vancouver Campus. Dr. Shroff, who also works in the Department of Family Practice and the School of Population and Public Health with the University of British Columbia Faculty of Medicine, emphasizes visioning and developing Health for All. A researcher, educator, and community organizer, she focuses on the areas of holistic health and spirituality, community development, and social justice, as well as health services policy research. As a consultant, Dr. Shroff has served many public and private clients; she has also worked for governments in Canada and non-governmental organizations such as the Downtown Eastside Residents’ Association in Vancouver.
While (y)our focus is of course Canada, I hope that the conference will consider an issue that we share to some extent with the developing world: access to (affordable) mediacations. MSF’s appeal of last week makes the point that medicines are not a luxury. Example: Competition from generic drug companies has reduced the price of HIV drugs by a staggering 99 per cent to less than $140 per patient per year. This has given more HIV patients a chance not only to survive, but to lead meaningful lives.
But Canada is participating in international trade talks that could jeopardize what has already been achieved, and put the lives of millions of patients at risk.
Damaging intellectual property rules in the U.S.-led Trans-Pacific Partnership Agreement (TPP) would give pharmaceutical companies longer monopolies over brand name drugs. Companies would be able to charge high prices for longer periods of time. And it would be much harder for generic companies to produce cheaper drugs that are vital to people’s health.
We need to keep prices low so our patients—and millions of others still waiting for treatment in the developing world—can get the medicines they need.
Time is running out. The talks are scheduled to conclude this fall. We need the Canadian government to reject damaging provisions that could make the TPP the most harmful trade pact ever for access to medicines.
Petition is at: http://www.msf.ca/tpp/#act
Time and $$ prevent me being at the conference in person, but I recommend this for your serious consideration.
Well said Farah!
I just have a couple of notes on health spending. Canadian total health care spending is estimated to be about $207 Billion this year. But public spending is about $144 Billion and provincial government health care spending is $135 Billion.
Canada’s health care spending did outpace GDP growth from 1997 to 2009 after falling behind from 1992 to 1997. However, since 2009, health care spending has been rising more slowly than GDP. This is true for total spending and even more so for provincial government spending.
It is definitely true that we spend a lot of money on health care course. And we could definitely spent it better — look at most elderly persons’ medicine cabinets! However, health care costs are not escalating beyond our ability to pay.
FYI, you can find the latest health care spending data at: https://secure.cihi.ca/estore/productFamily.htm?locale=en&pf=PFC1952. They will be updated in a few weeks. You can find a slide presentation on the 2012 CIHI NHEX data release at my website: http://www.michaelrachlis.com/publications.php. See everyone in Saskatoon next week!