A commentary by the deputy provincial health officer from 1995 to 2004.
The recent commentary from Ken Fyke, “Benign neglect is destroying Canada’s health system,” supporting correspondence from my colleague Dr. Perry Kendall and from Professor Donald Philippon does not suggest what needs to be done except “meaningful reform.”
There is a fix, but no one wants to talk about it. I will get to that.
Fyke documents how we got to where we are today. I would add the importance of the Lalonde report of 1974 that put the focus on the prevention of health problems and the promotion of health.
The Canada Health Act is intended to provide a “universal publicly funded, single-payer health insurance system” and “health services that are fair and equitable.”
It is intended “to protect and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial and other barriers.”
These are all laudable objectives but as many people are experiencing, we are seeing lack of access to primary care, lack of access to the latest in cancer care, significant delays in obtaining access to needed surgery for orthopedic and cancer surgery, and delays in being seen in emergency departments.
There are also services that work well like emergency cardiac care, emergency trauma care and emergency surgery, particularly if one lives in an urban area.
Many Canadians have significant savings and travel to the U.S., Mexico or other countries for care that is not available in a timely manner in Canada.
The 49th parallel has been called the safety valve of the Canadian health-care system. In addition, a significant number of Canadians are getting access to private care though such insurance as WorksafeBC and ICBC.
Members of Parliament have access to a private Public Health Services Plan that covers more services than available to all Canadians.
The military has its own Health Services Centre in Ottawa which is one of 32 Canadian Armed Forces clinics, which provide health services to CAF members and other people entitled to come to them for their health care.
Indigenous Services Canada funds or directly provides certain health care services to First Nations communities and funds the provision of certain community health programs for Inuit peoples.
The reason there is no easy fix is that the Canada Health Act does not allow any private pay, otherwise the federal government will reduce the transfer payments to the provinces, who are responsible under the Constitution Act to provide services to most Canadians.
The federal government has the provinces in a firm grip.
So, what is the fix? Because of the insatiable demand on health services due largely to continued advances in medical care, as well as public expectations, there must be some form of private pay or co-payment in the future.
No-one wants to talk about it because they fear a U.S. type of for-profit health-care industry. However, if you review the health services delivery in many other western countries — such as Australia, France, the U.K. and Switzerland — you will find there are different, albeit government-controlled legislated mechanisms (and accountability, as mentioned by Fyke) for private pay or co-payments. The U.S. has an uncontrolled for-profit health-care industry.
It is time to discuss this. Is this the meaningful reform that is needed?
Many older Canadians who need health care have savings that they are prepared to pay for access to the latest health-care technology. With some private pay there will be support of more innovations to improve health.
It will mean altering the wording of the Canada Health Act. Continually relying on taxation to fund health services means that provincial governments are having to squeeze other ministries — like education, the environment, social services etc.
Let us also not forget the importance of more emphasis on disease prevention and health promotion in preventing such conditions as obesity and emphasizing the importance of exercise in ensuring good health as we age.
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