Looking for Solutions in Health Care for 2006 and Beyond

Our health care system needs to change to accommodate new demographics, new technologies and new pharmacologic advancement.

The roots of compassion and caring in health care should not change however, and it is with this in mind that the dialogue of change should be had surrounding health care.

How can we adapt to different needs that emerge as our population ages?

How can we  find sustainability in the midst of so many new advancements?

How can individuals become more empowered in serving their own health care needs?

What role does the individual have in enabling the  health care of others  beyond paying taxes?

Many questions like these need to be answered and if we are willing to look with open minds at the problems within our health care system, and beyond political posturing, then we can find new  solutions to take us further into this century. 






Priorities, Wait Times and Patient-centric Health care: Compatible?

 The Wait Time Alliance graded the provinces' performance on wait time benchmarks and commitments earlier this month with grades from A to F.  So there  IS movement forward  in the Big Five, even if small, which is good. While government should be applauded for  acknowledging the need for  more funding and trying to improve it , we need to ask how far does $5.5 billion (earmarked for wait times) of the $41 billion (from the 2004 federal/provincial health accord) go to making a difference for the patient who requires an expensive medication for a rare disease/cancer or the patient with Alzheimers or the patient that doesn't fit these 5 favoured groups. Are the priorities outlined by the five wait time areas geared to patient centred care or not? Given the facts, it doesn't look like it.   We need another solution, a long term solution.

One in four Canadians will be older than 65 by 2031. We will be managing the health care of 9.3 million seniors in the relatively near future. At current rates, 744,000 Canadians will be afflicted by Alzheimer's or related dementia with associated costs of care, medication and infrastructure.

Canada's aging population will create a steady rise in the number of people developing cancer. In 2005, it was estimated that 149,000 Canadians would be diagnosed with cancer-thousands more than the previous year. Over the next 20 years, an estimated 3.6 million Canadians will develop cancer. The federal gov't has unveiled a national cancer plan with $260 million to improve cancer care which amounts to a few million per province.  This may be helpful for the time being but the long term picture isn't pretty.

In 1956, 39% of the population was under 2o, while 7.7% of the population was over 65.

In 2040, 20% of the population will be under 20, while 24.3% will be over 65.

According to Chief Economist Don Drummond at TD Bank, Medicare is getting hit hard by a double whammy of ageing population and expensive technology and by 2011 health care spending will be rising by 8-10% per year. Spending on health has been rising 6-7% a year, education 3-4% and all other discretionary spending has been flat or falling. 

People will need to work longer or more private sector involvement will be needed or taxes increased or use  co-payments to cover rising program obligations.  We already talk about working smarter and squeezing more out of a shrinking workforce but Canada is barely scraping out a 1% productivity growth recently....not really close to the 2.5% productivity growth needed to pay for mounting obligations.

If people are going to have to work longer and contribute substantial amounts of tax dollars to healthcare,  they should be able to get it when they need it  and it is not surprising that  the term "patient-centred" keeps cropping up.  It is  central to finding real solutions.

To have patient centric health care I believe we need three things:  adequate numbers of providers to provide the care required by the patient, adequate funding to treat and care for the patient and the funding to be attached somehow to the patient.

Personally, I don't think we have any of the above at this point and I don't think it can be achieved with the transformation agenda proposed to date. We will need more private sector involvement to provide the competition to create efficiency; we will need to openly discuss co-payments; we will need to discuss the use of co-operatives for healthcare; and we will need to consider a "last resort" insurance fund to send patients to other jurisdictions when the need arises  as the CMA has suggested.

Hope this post inspires some friendly and respectful debate by some familiar voices or new voices and I am privileged to have you all aboard. 





Open and Honest Discussion

As a physician working in  Ontario's healthcare system for close to  twenty years, I have witnessed many changes. An aging population, an aging provider workforce and ever advancing technologies and pharmaceuticals are contributing to create a healthcare environment in which public expectations  may very well not be attainable.

At some point, we need to discuss what our publically funded healthcare system can provide and what it can't and find other means to provide the rest. We need the input from patients, from the providers and from the public in general. This should not be left to politicians whose careers are mostly much shorter than the time required to find viable solutions. This discussion is too important to leave to politicians.

 Please join me in this discussion and post your comments. Please remember that although there is much passion associated with healthcare opinions, respect for differing perspectives must always be maintained.

I hope you find my future posts enlightening and thought provoking. 



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