The last two weeks in England were a gruelling and informative start to my Masters in Health Economics, Policy and Management at the London School of Economics. As I flew over Ontario, I looked out the window... and remembered.
My classmates chuckled when I said Ontario's health care system is crashing and burning — slowly. I get it. How could anything be "crashing and burning" in the most well-resourced, populous province of a first-world country?
Nobody wants to believe that the system in which they live is failing. But denial allows Ontario's usual M.O. to persist: A crisis occurs. Public outcry spills into the media. The provincial government scrambles for a last-minute solution usually involving fast cash. The dust settles until the next crisis.
Problem is there seems to be no end to the crises: the stem cell transplant fiasco; the neonatal ICU bed shortage; the nursing home crisis; the First Nations suicide epidemic. The government plugs one leak only to have another spring up. Decades of Band-Aid solution after Band-Aid solution have created a health care system that is bureaucratic, redundant, irresponsibly expensive — and disturbingly inequitable.
Canadian taxpayers pay a lot for health care, even more than the U.K. (which has its own issues). Ontarians in fact pay an extra health premium on top of regular taxes. Yet, we get fewer services. One example: except for a £7 co-pay, necessary medications are covered for all ages in the U.K.
Ontario does not have a universal health care system. We have a piecemeal, jumbled system that helps some, but not all.
Starting Jan. 1, 2018, OHIP+ will cover drugs for those aged zero to 24 years. Like other targeted programs, this will help some, but not all. Just like the Ontario Drug Benefit program helps those over 65. Or Ontario's Workplace Safety and Insurance Board helps injured workers. Or the Ontario Disability Support Program helps disabled adults.
Ontario does not have a universal health care system. We have a piecemeal, jumbled system that helps some, but not all. The inequity is jarring.
It's nearly 2018, yet parts of Ontario still don't have clean water. Think about it: moms, dads, grandparents and even children don't have clean drinking water. I was ashamed saying this in front of classmates from around the world, including low- and middle-income African countries. "How is this possible in Ontario?" they asked.
Worse, we have First Nations child after child hanging themselves. There are no ambulances there. So when another child is discovered, parents, doctors, nurses — they jump into pickup trucks and race against time to cut down and save those kids. The doctors, who work under appallingly under-resourced conditions, say the system fails First Nations communities every single day for "arbitrary administrative reasons." I can't imagine what those communities face but I respect their resilience. And I'm still angry this happens.
In Northwestern Ontario communities like Kenora, Fort Frances and so on, maybe half the necessary number of doctors remain. Specialists are few and far between, so family doctors stretch to fill the gaps in the emergency department, inpatient services, mental health, community clinics, obstetrics and anesthesia. Many are burning out. They all struggle under intense pressure to do more with less... just as their patients do more with less. Skyrocketing hydro prices this summer forced many rural families to choose between heating and eating. Winter is here; I wonder — how are those families now? If heat and food are unaffordable, how do they pay for medications?
Further inland in Kingston and Ottawa, doctors rail against insane waitlists lasting up to 4.5 years. One referral even said, "Please accept our apologies" if the patient died while waiting.
The firestorm of responses to Andre Picard's callout, #CanadaWAITS, suggests that wait lists are out of control for too many patients. Professor Alistair McGuire said, publicly funded systems use wait lists to divide scarce resources within a population. But at what point can we say that patients are waiting too long?
Hospitals nowadays need generous donations to keep going. "Overcrowded" and under-funded, hospitals have simply run out of space to care for the sick. The euphemism "unconventional spaces" means patients are now billeted in broom closets — lacking privacy, necessary equipment and dignity. Hospital executives — who a year ago felt "unsafe" speaking up — now have no choice but to protest. Closed wards and hospitals are re-opened with a temporary infusion of cash — more Band-Aid solutions to survive this crisis.
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At least 800,000 Ontarians do not have a family doctor. But each year, more and more become "multi-morbidity" patients: they don't just have high blood pressure, they also have diabetes, high cholesterol, clogged arteries etc. And each year, they need more time, more attention and more work to prevent devastating complications like heart attacks, heart failure, kidney failure, atrial fibrillation, strokes. Family doctors are uniquely trained to manage complex preventative care. Without this care — this constant juggling of medical conditions, medications, monitoring and social issues — some patients fall in a domino effect of illness after illness, hospitalization after hospitalization.
The kicker: some are only 50 to 60 years old, busy raising kids, busy working, paying down mortgages, caring for elderly ailing parents. If they go down, everything that depends on them may collapse, too. The best way to care for complex patients? Team-based clinics led by physicians. But the Ontario government restricted those in 2015.
The pendulum of cost-containment swung too damn far in the last 10 years.
Faced with a broken system on one side and increasingly complex patients on the other, it's no surprise that many family doctors stopped accepting new patients. Some are even downsizing their practices just to maintain standards of care. Worse, fewer graduates are choosing family medicine.
This is not just a manpower issue. It's not just a funding issue. The health care crisis is a poor government policy issue. The pendulum of cost-containment swung too damn far in the last 10 years.
We must find smart, sustainable solutions. There is no alternative. Crashing and burning — slow as it may be — is not an acceptable outcome.
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