A new year is always a time to reflect and think about the future. This is a special new year. As Canadians, we are fortunate to celebrate our 150 anniversary. In so many ways we are a young country built by immigrants and the existing indigenous populations.
For years public health authorities have been sounding the alarm. But the tone has become more urgent in recent years -- with terms like "burning platform" and "crisis" increasingly used. This is having a profound impact on the health of millions of Canadians, and costs our health-care system billions of dollars per year.
Whether it's a result of increased need, improved awareness or maybe both, millennials are asking for help in the form of access to mental health services that are often fragmented province to province and particularly difficult to access. Millennials are also most likely to be underinsured or have no insurance at all.
Today's disjointed pharmaceutical policy may be described as a Shakespearean tragedy -- a flawed system that will always end with demise. The relationship between health care policies, the funding of prescription drugs and public access to medically necessary medication is fragmented. It is in need of political leadership.
In my experience, equity in Canada's health systems is discussed a lot, but that seldom translates into effective action to ensure equal access and equal outcomes for all people regardless of their race or culture. Provinces rarely have a person who is in charge of health equity; lacking health equity plans or targets.
Health-care cultures that will not acknowledge or admit to medical errors, and therefore fail to learn from them, or permit expressions of resentment and disrespect by care teams (and administrators) to patients and families seeking information are the very antithesis of what patients need and what a caring society should accept.
Understandably, prescription drug coverage only becomes a concern for many individuals when they can't access the drugs they need because of cost. If you haven't personally experienced problems with drug coverage, there is a high probability that your child, friend or loved one has.
The field of medicine is one of the most sought after professions in this country, with admission rates around 26 - 28% of domestic applicants in a given year gaining acceptance to a Canadian medical school. Given such a low admissions rate, there are far fewer positions than qualified applicants. How, then, should we choose those who are admitted to medical school?
In terms of health care, we have it pretty good. If you are unfortunately diagnosed with cancer, most, if not all of your treatment will be paid for. If you break your leg, you can go to the ER and get a cast and leave without a bill. If you require surgery, the government will pay for that too. But what if your issue isn't physical? What if what's holding you back in life is a mental concern? Well, then you're kind of out of luck.
For many decades, physicians themselves have resisted unionization. There's never been an article written on why, but my sense is that for whatever reason, they felt unions were "beneath" them somehow as professionals. I've also had more senior physicians express to me concerns about a loss of independence if one were in a union.
When I was in training, most family doctors worked only with other family doctors and registered nurses. Today, my health care team is rich with a variety of critical skills. But what's missing -- and should be an essential part of any healthcare team -- is the digital expert.
Calls for a government-operated national drug insurance program have been getting louder over the past few months, culminating most recently with premiers from across the country signing a "prescription" for "National Drug Coverage." The notion that a national government-run drug plan is the obvious solution is misguided.
I had a vision of cultivating a practice where patients felt heard and cared for, and where I could provide full-spectrum family medicine care, including obstetrical care. My practice embraced the principles of patient-centered collaborative care. It employed the latest in 21st-century technology. I loved my work and my patients. But after five years of constant fighting with multiple private insurance companies in order to get paid, I ultimately made the heart-wrenching decision to close my practice down. The emotional stress was too great.
Right now the strategy seems to be to make it as difficult as possible for families to navigate the system and find the care their loved one needs. There are so many rules which means that the patient isn't eligible for this or doesn't qualify for that.
Many doctors who work in group practices are now paid a flat fee, per patient, per year. It essentially means the physician gets the same amount regardless of whether you have just one appointment or 10 appointments a year. So a doctor paid on that basis doesn't really lose money if a patient misses an appointment. However, protecting the doctor's income is not the sole motivation for imposing a "no-show" fee.
Canada should and could have a role, working through the World Health Organization, to create such basic systems, through international aid. But, it must also look internally to the failure of our own health system to serve the needs of our Northern peoples where TB is highest (234 cases per 100,000) primarily because of inadequate housing and overcrowding.