A Medicare@50 blog post by:
Dr. Monika Dutt (@Monika_Dutt)
Chair, Canadian Doctors for Medicare
Dr. Dan Raza (@DanyaalRaza)
Board Member, Canadian Doctors for Medicare
The care that we provide as doctors is a small contribution to what makes a person healthy. Medical care is essential, but it needs to be in a broader context that includes other health-related providers and addresses the conditions that affect health at a community level. This more inclusive approach to health was acknowledged in Tommy Douglas’ original vision of Medicare. The first stage of Medicare entailed physician and hospital services, and was intended to lead to a second stage of Medicare. Unfortunately, that progression hasn’t happened.
It is the second stage, with its focus on health promotion, illness prevention, and primary healthcare, that remains largely outside of the purview of Medicare as it exists today. Canadian Doctors for Medicare (CDM) supports the mandate of Community Health Centres (CHCs), which includes collaborative care, preventive medicine, and a focus on the social determinants of health, as it embodies the intent of this second stage of Medicare.
As physicians, we have practiced in settings ranging from urban centres to remote northern communities. We have worked in places where CHCs thrive and provide excellent medical care as well as integrated services such as breastfeeding support, dental hygiene, and early years interventions. CHCs are often leaders in areas such as food security and employment training that relate to factors with significant health impacts such as income and education. In contrast, some communities we’ve worked in that have no CHCs suffer from fragmented patient care, often with poor or non-existent preventative services. There is little formal connection between the multiple supports a client might require, and public health struggles to address daunting social and economic issues without a clear link to the healthcare system.
Canadian Doctors for Medicare acknowledges many of the challenges CHCs face, well-outlined in Scott Wolfe’s recent blog. Despite promising models, there are difficulties with inconsistent standards across the country. CHCs often lack the resources to be able to adequately address their broad mandates. CHCs often provide services to specific populations with greater health and social needs; however, without a comprehensive provincial/federal approach to marginalized communities, many areas remain under-serviced. Ensuring integration and collaboration between CHCs and allied health services is also challenging without an overarching structure.
In order to strengthen the preventive focus of CHCs, they need to be supported and expected to incorporate a strong evaluation component into their work and to disseminate their findings. CHCs could be leaders in evidence-informed preventive healthcare from the individual to the policy level.
CHCs clearly fit with the ideas put forward for the second stage of Medicare. Canadian Doctors for Medicare supports the work of CHCs, in conjunction with other necessary healthcare system improvements such as a national Pharmacare program, and homecare and long-term care reform across Canada. Improving and strengthening the CHC network across the country in an equitable manner would be a benefit to the health of Canadians.
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