We Canadians tend to be both proud and defensive about our healthcare system, but it does have real problems. Via The Globe and Mail, André Picard points out some of them: The real challenge to Canada’s health system is not wait times. Excerpt:
The solution to problems like waiting times is not always to do more of the same. For example, the CIHI report notes that Canada relies on doctors to provide care more than any other country; in other words, we underuse nurse practitioners, occupational therapists and the like.
More than anything else though, what Canada needs to fix its systemic health-care woes is to create a semblance of a system.
What distinguishes the countries that have markedly better results than Canada – like the Netherlands and the Nordic countries – is the cohesiveness of the system, and the emphasis on primary care.
Every Dutch citizen must register with a general practitioner, who acts as navigator and gatekeeper for the system. Furthermore, the roles and responsibilities of all the key players in the system – practitioners, insurers and government – are clearly defined, and complementary. Better still, politicians do very little micromanaging of the health system because that is not tolerated.
In the Nordic countries, in addition, there is a particular emphasis on the socio-economic determinants of health, in tackling inequality, but spending more on education and social welfare, and less on health, with impressive results.
In Canada, by contrast, we have very much a sickness-care system, with many silos, and very little co-ordination. There is far more crisis management than planning and political interference is commonplace. And, as the data in the new CIHI study highlight, patients are often left to navigate the complex system on their own, and too often fall between the cracks.
Canada’s motto is a mari usque ad mare (from sea to sea). In our beloved health-care system, sadly, our motto has become a mora usque ad moram (from wait to wait).
But the real challenge we have is not waiting times. It is more fundamental: To provide the right care at the right place at the right time at an affordable price (to individuals and society). To do so, we need vision and we need a system; not just data, but a willingness to act on the data.