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.