The complexity of ageing arises because, as we age, we are more likely to have more than one illness and to take more than one medication. And as we age, the illnesses that we have are more likely to restrict how we live -- not just outright disability, but in our moving more slowly, or taking care in where we walk, or what we wear or where we go.
Since the inception of medicare in Canada, opinion polls in all parts of the country consistently show that a vast majority of Canadians believe in equal access to health care based on need, not ability to pay. Yet this is precisely what is at stake in the Charter challenge against medicare taking place in the B.C. Supreme Court this week.
The latest convergence of healthcare and smartphone technology is, an open source framework that allows developers to create apps specifically designed for medical research studies. The open source element makes these studies accessible to everyone, exploiting the power of the collective to continuously refine and build on existing technologies.
We desperately need universal coverage for a full array of health care goods and services -- pharmaceuticals, mental health services, home care and out-of-hospital diagnostics. Canada is unique among OECD countries in the paucity of what it covers on a universal basis despite falling in the top quartile of countries in levels of per capita health spending.
Too few Canadians have access to medically necessary prescription drugs. Canada is the only country with a universal health care system that does not include prescription drugs. This has created a paradox where Canadians can see their doctor at no cost but many have no ability to purchase the drugs that they are prescribed and that they need for good health. One in 10 Canadians doesn't take a prescription as directed because of cost.
In the U.S., the Center for Patient Protection recently reviewed the data top hospital rating organizations provide about hospital safety performance. They cover the smallest community hospitals right up to the biggest teaching facilities, in a format where access to the information is quick and user-friendly. You won't find similar information anywhere in Canada.
Cities have to spend this money, taken from local taxpayers, because Canada's medicare system is the only universal, public health care system among developed countries that does not include universal coverage of prescription drugs. It is not wrong for cities to care for their employees. But leaving these costs to the cities makes about as much sense as requiring every homeowner to maintain the roads and infrastructure surrounding their property. Here's why.
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.
The dismal record of for-profit hospitals illustrates the problem with running hospitals as businesses. The for-profits have higher death rates and employ fewer clinical personnel like nurses than their non-profit counterparts. But care at for-profits actually costs more, and they spend much more on the bureaucracy, a reflection of the high cost of implementing shrewd financial strategies. Canadian hospital administrators don't have to play financial games to assure their survival.
Employers want their drug plans to be as competitive as those offered by other employers. So what happens when the norm is to cover all new drugs at any cost, even if the drugs do not provide additional therapeutic value? Well, the end result is that everyone buys "generous" plans instead of increasing employee compensation. Everyone we spoke with agrees about the need to educate employees and employers alike. And in fact, everyone agrees (even insurers) that exorbitant drug costs are a big issue for Canadians.
While policy should be evidence-informed rather than belief-based, the complexity of health-system change makes it difficult to draw a straight line from one evidence-based improvement to health-system change as a whole. Improving the quality and quantity of evidence-based decision-making is perhaps the greatest challenge in systematically devising policies for bending the cost curve.
The Liberal government of New Brunswick appears to be stepping back from the brink of mandatory prescription drug insurance. And so they should. The drug plan chosen by the Conservatives was designed on a false premise: that the private sector can better manage things than government can. In many sectors, that might be true. But not in health care.
Most Canadians probably don't realize that health care in Canada is quietly undergoing a major transformation in funding that could significantly impact patients. Three provinces -- Quebec, Ontario and British Columbia -- are implementing a new funding model for hospitals and other provinces are watching with interest.
Rather than placing a tax on health needs -- as income-based drug plans do -- Ontario should consider a more positive road to universal pharmacare. Specifically, it should consider tax financing a universal drug benefit program that would give non-seniors the same coverage elderly residents enjoy today.
Last fall when I visited Canada, I met a Toronto doctor named Gary Bloch who has developed a poverty tool for medical practitioners. Bloch's idea was to zoom in on the social determinants of health -- food, housing, transportation -- all poverty markers linked to bad health and poor health outcomes.
Yes, we do ration healthcare in America. It's just that those affected the most are those who have the least income. In America, we have become oddly blasé about income inequality and its consequences, increasingly willing to let those without simply do without. But the mere hint that a needs -- or evidence-based -- process might be used to allocate scarce or high-priced healthcare raises an outcry from those accustomed to getting what they want, when they want it.
Beyond Quebec, despite the endorsement of the public health and policy community, a Health in All Policies approach has not found the political will necessary for meaningful change. But the past year offers signs of hope, with governments in Canada from across the political spectrum beginning to see the potential.