A version of this commentary appeared in the Winnipeg Free Press, the Huffington Post and the Medical Post
A federal election could be called any time in the next few months, judging by the media coverage and the ramping up of political activity. Many issues have been crowding into the media headlines in anticipation of the election — but with a notable absence of any consideration of healthcare by our political parties.
Apparently the subject is still on the minds of the electorate though, at least amongst my own circle of friends, colleagues and neighbours, many of whom note the leading edge of our baby-boomers have now turned 65.
A good starting point could be an overlooked recommendation in the Romanow Report (#5) tabled in 2002, which suggested that our Canada Health Act needs to be both modernized and strengthened in order to reify the principles of public administration, universality and accessibility. The recommendation also suggests we need to update the comprehensiveness of our health system and create a new principle of accountability.
The recommendation is breath-taking in its scope — all the more since it is still relevant in 2015. Sadly, little, if any, progress has been made in the intervening 12 plus years since Romanow — and certainly not in the area of accountability, a sticking point for many Canadians.
Some of the key issues in healthcare that need renewed public focus include making the healthcare transfer payment details to the provinces and territories more clear; clear goals and objectives for provinces and territories to “buy change” in delivery models that measure health outcomes of interventions and ensure that these interventions reflect best practices.
Clearly, the enforcement of the Canada Health Act by the federal Minister of Health is not occurring nor is it clear with whom the responsibility lies, so this needs to be revisited. It is also not clear what the impact of trade agreements may be on the future of medicare — so it is imperative to have this discussion.
Finally, the creation of a national pharmacare program — the feasibility and implementation – has been largely neglected by the current federal government, but not by the general public.
Providing answers to these questions is the task of those who seek to represent us in Parliament; seeking answers to these and other questions is the responsibility of concerned citizens.
From my direct experience as a physician and as a patient, medicare generally delivers on its promise of providing care for all in a timely and effective fashion. Unfortunately wait times for total joint replacements are now increasing in some jurisdictions. While the principles of universality, comprehensiveness, accessibility, portability and public administration continue to resonate with Canadians, we must maintain a constant vigilance of medicare’s performance.
Where do we go from here?
While many progressive options are possible, one choice that has the potential for high impact with the prospect of an enormous return on savings merits our attention: the adoption of best practices across provinces and territories.
In 2010, the Organization of Economic and Cooperative Development (OECD) estimates that on average, member states could save two percent of their GDP by 2017 with the adoption of best practices in their healthcare systems, and that Canada could save 2.3 percent. Given that Canada’s GDP is approximately $1.825 billion, this suggests the possibility of a savings of over $40 billion ($41.975) annually.
What does it mean to adopt best practices?
Simply put, an evaluation of success stories in healthcare delivery across Canada reveals “nuggets” in almost every jurisdiction. An example is the Alberta Bone and Joint Healthcare Institute that has revolutionized musculoskeletal care including hip and knee replacement, reducing wait times, shortening hospital stays and increasing satisfaction of patients all in a cost-effective manner.
Another example is the practice of Patient Centred Care in the primary healthcare setting based on care, communication and common ground and treatment based on the best available evidence that patient and provider agree upon. This approach has been shown to reduce unnecessary tests, decrease the number of physician visits needed and provide higher satisfaction and better outcomes in the management of chronic conditions such as hypertension.
For a healthcare system to continue to serve Canadians into the future, continued vigilance and progressive change with cost constraint must be attractive to policy and decision makers. Now it’s time we heard what our political parties plan to do for medicare.
Robert Y. McMurtry is an expert advisor with EvidenceNetwork.ca, an active orthopedist and formerly Dean of Medicine at Western University and Assistant Deputy Minister of Health Canada. He was a special medical advisor to the Royal Commission of the Future of Health Care in Canada (Romanow Commission).