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Tackling the challenges of medicare

July 10, 2014
Dr. Monika Dutt and Dr. Vanessa Brcic, Hamilton Spectator

This year, the Heritage Department asked Canadians what historical moment or achievement made them proudest of their country. The top answer? Medicare.

All too often, discussions regarding our medical system take disparaging turns. Legitimate frustrations about access to care and wait times are seized upon by proponents of for-profit health care who seek to dismantle our current health delivery model.

Are there problems with our current system? Certainly. Access to services remains unequally distributed and wait times for some appointments and procedures remain too long. But the pride that Canadians feel about Medicare should motivate us to address these challenges and improve our health care system.

In his book, Down to the Wire, David Orr explains the difference between optimism and hope. This distinction is an important one when we try to balance our pride in the Canadian health system with our frustrations about its challenges. To Orr, the optimist is someone for whom the deck is stacked. In situations like this, feeling positive comes easy. Hope is fundamentally different. It is the commitment to positivity in the face of adversity. "Hope is a verb with its sleeves rolled up. Hopeful people are actively engaged in defying the odds or changing the odds."

Canadians haven't given up hope for better Medicare: a system that can rise to its challenges.

Our universal health care system was created by hopeful people who — at a time when illness led to bankruptcy — believed that all Canadians should have access to care based on need, not ability to pay. Since then, it has been a front line of committed, hopeful health care workers, researchers, and advocates who have spearheaded pilot projects and programs to improve the capacity of this system to serve patients across Canada.

An exceptional example of innovation improving health care delivery in Canada is the e-consultation project from Ontario's Champlain region. Erin Keely, chief of endocrinology and metabolism at The Ottawa Hospital, believed that changing the ways in which family doctors and specialists interacted could improve wait times and patient experiences. Within its first year alone, the project enabled faster and better communication between 116 primary care providers and specialists in 20 fields including cardiology, neurology, and psychiatry. In 42 per cent of cases, a referral was avoided, and duplication of tests were avoided through better information sharing. Under this program, the average response time for a referral was just two days.

Similarly, in British Columbia, the Rapid Access to Consultative Expertise program provides a smartphone app and direct phone line for family doctors to talk to a specialist while the patient is in the office. Each phone call saves the health system about $200, and saves the patient the cost and burden of travelling to another appointment while increasing access to virtual shared care within primary care clinics.

Dr. Michael Rachlis' book Prescription for Excellence provides a wealth of examples of public system solutions, recognizing that simple innovations can have incredible impacts on wait times for patients. During the 2000 flu season, which gridlocked Toronto emergency departments, Saskatoon, Edmonton, and Calgary avoided such a fate by streamlining services and implementing integrated care teams that linked home care services and long-term care planning to Emergency Departments.

Given the rise of for-profit orthopedic clinics, it is important to highlight the work of the Alberta Bone and Joint Health Institute in orthopedic solutions that benefit all patients. Since 2010, orthopedic wards throughout Alberta have improved quality and access through better reporting and identification of key benchmarks for wait times for surgery and length of hospital stay According to Dr. Donald Dick of ABJHI, over the past 10 years "Alberta has increased the number of hip and knee surgeries by 73 per cent with only a 5 per cent increase in the use of hospital beds." Between 2010 and 2013, the average wait for a surgery consult dropped to 15 weeks while the wait time for surgery dropped to 18 weeks.

The findings of the Heritage Department's survey remind us that Medicare remains a point of pride for the majority of Canadians. It's an extraordinary thing, to have a system that ensures that all 35 million people living in Canada have access to care based on need, not their ability to pay. But pride is not enough to sustain our system.

Building a more equitable and effective health care system requires hope and hard work. Let's kick off Canada's 147th year by committing to learning from the lessons of successful health care innovations and explore implementing them across the country. It's time to roll up our sleeves and help make Medicare better care.

Monica Dutt is the chair of Canadian Doctors for Medicare, a public health and family physician, and is based in Cape Breton, N.S. Vanessa Brcic is a board member with the Canadian Doctors for Medicare, a family physician, and a clinician scholar in the department of Family Practice at UBC in Vancouver, B.C.