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
The recommendation is breathtaking 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 health care that need renewed public focus
include making the health care 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
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
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 per cent of
their GDP by 2017 with the adoption of best practices in their
health-care systems, and that Canada could save 2.3 per cent. 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 health-care 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
health-care 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 health-care 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
Putting health care on the federal election agenda
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 health care by our political parties.
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