BY DIANE KELDERMAN
I must admit I am tired of this same old, same old debate. Can we, please, turn the conversation to ideas, options and solutions?
Canada’s health care system, created 40 years ago expressly to ensure that all Canadians could receive the same high-quality care regardless of their province, territory, or income level, is in trouble. We all know the facts.
Far too many people are without a family doctor. Far too many rely on walk-in clinics or hospital emergency wards for treatment that could be provided by a family doctor. Local seniors in residence can go by ambulance to a hospital emergency department when a home visit from a doctor could serve just as well.
You can’t phone a doctor who knows you and your family, at a cost of $30 to the Province, but you can phone a 811 number and talk to a nurse whom you’ve never met, at a $60 cost per call to the Province. Waiting times are too long. People are suffering.
And, it is costing us a bundle. About 45 per cent of government program spending (federal, provincial, and territorial) is currently directed to health care, or 9.6% of Canada’s GDP.
The Medical Care Act (1966) and the Canada Health Act (1984) planted government squarely in the driver’s seat of our health system. Government was appointed the sole insurer of a wide range of health services, including medically-necessary services delivered by doctors, in person, anywhere in Canada and almost all services provided in hospitals. Doctors’ practices remain largely private, but they depend on government to pay almost all the bills, however.
From its position as the ‘single payer’ for services, government evolved into the administrator, the regulator of their cost and quality, and the monitor and evaluator of how they were provided.
Unlike other sectors, when it comes to health care, Canadians decided it was practicable and even praiseworthy for one and the same party to exercise tremendous power over just about every aspect of the supply chain. It is a near-monopoly that places intolerable demands on government. And it has placed government in a conflict of interest that makes a rigorous level of accountability extremely unlikely.
The last 40 years of health care has caused another ‘adverse reaction.’
A public perception has grown up that health services are primarily about addressing ill health, not maintaining or promoting good health. Prevention, wellness, self responsibility should be the focus. It is not. This creates some very real expectations about the setting, expertise, and costs of health services, and who has to provide them. ‘Health’ is considered a personal responsibility, yet ‘health services’ are largely something that a professional does for us when we are ill, with pricey pharmaceuticals and equipment, often in a clinic or hospital.
Isn’t it time we changed our thinking?
What if you and your neighbours (your community) came together to hire a family doctor or other health professional. As a group, you agree to pay for what you feel is missing from the current menu of insured services. Email and telephone consultations, electronic personal health records, the ability to book appointments online, the ability to get your lab results electronically, house calls, and the availability of your doctor for calls from you after office hours?
Through your control over the menu of services and the revenue flow, your community-owned facility is in just as good a position to deliver quality care as one funded solely by government. Better even. You know exactly which types of service local people want, and which are not so important. You can insist that administrators provide timely and pertinent information about access to care and the outcomes of care, and can set the standard you want achieved, not the standard some distant bureaucrat considers good enough.
Sound possible? It is!
There’s over one hundred health care co-operatives operating in Canada today, where ordinary people have a say in the design, delivery, and evaluation of health services that they and their neighbors receive.
Imagine a model that helps governments to extricate themselves from the role of manager and evaluator, and unleashes an entrepreneurial way of thinking on the delivery of services that are medically necessary.
As the World Health Organization concluded at the International Conference on Primary Health Care in Alma Ata, in 1978, ‘people have the right and duty to participate individually and collectively in the planning and implementation of their health care.’
Dianne Kelderman is the president and CEO of the Nova Scotia Co-operative Council. She lives in East Mountain.
