By Katy Heath-Eves
Canadian medicare is resting on shaky ground and even resuscitation attempts have shabby prospects.
Despite a general sigh of relief when the federal government restored some funding in the 1999 budget ($11.5 billion over the next five years), indications of continued massive underservicing coupled with fears of the brain drain threaten the integrity of the entire system.
Public confidence in medicare is dwindling.
At the bequest of the provincial government, the Ontario Medical Association, which represents Ontario doctors, is slowly trying out changes to what is called “primary care.” The main element of this reform is an attempt to roster patients to groups of doctors in seven pilot projects across the province, one of which is underway in Blackburn Hamlet.
The theory is that if the provincial health department, which pays for health care, encourages more family physicians to establish around-the-clock clinics with their colleagues, fewer patients will have to go to crowded hospital emergency wards for treatment. Doctors would be paid a set fee per month per patient depending on the patients’ age and other characteristics.
The trouble is, patients don’t want to be enrolled in a clinic and doctors want to be paid for the services they provide, not the number of patients they care for. In Wawa, an eighth pilot project was scrapped because patients and doctors alike hated the system.
But something needs to be done.
We’ve all seen the headlines. Hospital beds are full, staff are overworked and many are threatening to resign or have done so already.
Adding to the problem is Ottawa’s growing aging population. Seniors occupy a third of all hospital beds and are three times more likely to be hospitalized than the population as a whole. While the average length of hospital stays in Ontario is about 10 days, for those aged 65 and over it’s 18 days.
As the population continues to age, the existing network of medical resources appears woefully unprepared to deal with the burden of chronic disease.
To cope with the aging population, federal Health Minister Allan Rock is pushing for the establishment of a national home care program. If Ontario agrees to endorse the program, Rock says the federal government will shoulder half the cost.
If home care programs are improved, Rock maintains there will be fewer patients occupying expensive acute-care hospital beds and creating the surgical and emergency ward backlogs that now dominate the headlines.
How changes like primary care reform and home care affect Centretown is up for debate. Some say Centretown clinics offering primary care, such as the Somerset West Community Health Centre, are absolutely brimming with patients. And yet, there are doctors in Centretown whose practices have so few patients they may have to close.
It seems no one is tracking these disparities. Isn’t the best health care system one where everyone enjoys speedy and skilled service?
The provincial premiers held a meeting in Quebec City. They accused the Chrétien government of indifference to medicare’s problems and demanded more health funds from the bursting federal treasury.
The premiers are missing the point. Although a lack of money is certainly an issue, it always will be, especially with an aging population.
There will always be new medical technology to buy, new hospital wings to build. In Centretown at least, the problem appears to be a lack of communication between patients, doctors, and their medical associations.
An increasing reliance on walk-in clinics in Centretown and the possible implementation of patient-rostering point to trouble.
Walk-in clinics, where patients and busy doctors meet only briefly is not a model anyone would recommend but no one seems happy with the possibility of having to sign up with a single group of doctors either.
For patients this means less choice and for doctors it means losing the autonomy of the fee-for-service method of payment.
We have to keep our doctors happy (and home in Canada) if they are to keep us healthy.
Primary care reform should be ditched, and a national home care system set up to care for the aged. And if community-wide studies are performed on a regular basis, tracking costs and which patients use which facility, and how much it costs for each patient, then all patients might enjoy more complete access and care.
Centretown and all of Ontario need a plan for the reorganization of its health care system, not just money.