We could do better with health care
Although published in 2011, Health Care in Canada: A Citizen’s Guide to Policy and Politics by Katherine Fierlbeck is still mostly current and a good read for those of us who stay awake at night asking whether our health care system is the best we can do. Fierlbeck’s answer to this question is no, but change will undoubtedly cost someone more (probably employers and employees).
The author takes us on a journey that covers a wide variety of topics related to health care in Canada. These include a description of how the Canada Health Act works (or doesn’t), an outline of federal versus provincial jurisdiction, and a discussion on why the author believes that our public system – with all its flaws – is still superior to allowing the expansion of more private health care offerings. Fierlbeck also reviews the Supreme Court decision regarding private health insurance in Quebec and the current court battle still raging in British Columbia and most likely heading for the Supreme Court as well. She identifies the potential stumbling blocks facing any major changes north of the 49th parallel given our free trade commitments with the USA. Her analysis also includes a look at what is driving significant system cost increases, a review of how drugs are approved and priced in Canada, and the challenges in addressing mental health in a system designed to fund episodic care.
Below I list some of Fierlbeck’s most memorable insights.
Fierlbeck notes Canada already has a two-tier health system where only primary and hospital services are covered by public insurance. Other goods and services, like dental care, home care, long-term care, physiotherapy, optometry, drugs, off-site mental health, and other allied health services, are left to those who can afford to pay as needed or for supplemental private insurance. This reality is getting worse with each passing year, as more Canadians, with what used to be terminal but are now ‘only’ chronic illnesses, seek health care services outside of hospitals and other public institutions.
After describing a selection of pros and cons of allowing private insurance for medically necessary services, Fierlbeck concludes that “it makes no sense to address issues of ‘sustainability’ by privatizing health care, as we have good evidence to show that higher levels of private health care would only drive costs higher.”
Fierlbeck says that the 1984 Canada Health Act fragmented access to mental health services and imposed severe difficulties in the attempt to provide collaborative care within the area of mental health. She states that “The remuneration of physicians as private players but not psychologists, social workers, psychiatric nurses, or occupational therapists means that accessible mental health care has remained physician-driven, institutionally oriented, and expensive.”
In her review of health services in other countries, she describes French and German systems as worthy of Canadian ‘envy’, with no long wait times and more comprehensive coverage of services. How do these countries achieve this? She says, “Arguably, because these countries impose higher taxes on their citizens and they pay their doctors considerably less.” Fierlbeck argues “Canada might therefore be able to improve its comprehensiveness and accessibility as effectively by raising taxes and severely cutting payments to doctors as it could by implementing a social insurance system (although few would see either strategy to be a politically viable one).”
Fierlbeck concludes her book by outlining a vision for Canada’s “single payer-publicly funded” health care system with more emphasis on primary and preventive care, a better utilization of electronic health information technology, a shift to a payment system that rewards quality, more application of evidencedbased care, and a focus on long-term care.
Norm Letnick is the MLA for Kelowna Lake Country and the Opposition’s health critic.