The recent provincial election campaign made clear that for politicians the most important priorities are the economy and government deficits, a theme that also marked recent national and municipal election campaigns. We are being asked to believe these are our most urgent concerns.
As much as they matter, however, the issue that is of most concern among Canadians is our universal healthcare system. It is so important to people in general that among the three major parties, as they sought election, none dared talk about the looming crisis in funding healthcare and the need for rehabilitation of the system.
Four million Canadians don’t have a family doctor, according to Statistics Canada. And it is not just those without a family doctor who have concerns about proper access to healthcare. The challenge that has to be met involves finding money to respond to the number of people who will need healthcare as the bulk of baby-boomers move into their retirement years.
Each year, about 12 per cent of the federal budget goes to healthcare transfer payments. In 2009, that amounted to $129 billion – in public sector dollars. The year before, federal funding for healthcare was $171.9 billion.
Healthcare spending dominates every province’s budget; in Ontario that’s about 47 cents of every tax dollar spent by Queen’s Park. And future spending is expected to grow to 50 per cent of provincial budgets. One projection is that in 25 years when the number of seniors will be double the current 14 per cent, and those 85 and older will quadruple, healthcare will account for three-quarters of every dollar spent by any province.
If we are to see our deficit have a chance of being paid down by 2016, as all the political parties have promised, then it stands to reason that the healthcare system and its system of payments must be overhauled. That means there must be greater efficiency in how the system works.
Far too many medical professionals are bogged down with addressing bureaucratic policy rather than attending to sick people. Forty per cent of a nurse’s time is spent doing clerical tasks as opposed to spending that time caring for patients. We have a healthcare system that provides patient care expensively – expensive hospitals and technology, and highly paid doctors. Countries that spend more money on healthcare don’t necessarily get the best outcomes.
So, how do we change our primary care and acute care to better meet the needs in the current patient population?
The answer is to spend smarter by taking advantage of less expensive kinds of health services.
Why, for example, aren’t we talking more about the role that homecare support services can play? Providing extra services at home such as public health nurses, or providing increased education regarding personal healthcare would be a more efficient use of resources.
Ontario’s Minister of Health, Deb Matthews, needs to explore changing the fee for service system of payment to medical professionals since, for example, the aim for higher fees is likely what is driving the hasty visits you get at a usually crowded clinic. It may be time to look at giving salaries to doctors instead, as a way to control costs.
An efficient healthcare system will enable care providers to better coordinate and manage patient care. It also means the shortage of long-term care facilities and adequate homecare support have to be addressed immediately.
In hospitals across the country, at a cost of $24-billion a year, 7,550 acute care beds are occupied daily by people who should be in long-term care residences or in rehabilitation.
A new accord on healthcare transfer payment will be drawn up in 2013-14 between the provinces and the federal government. If health spending is to be brought under control the provinces will have to present a case for greater efficiency in healthcare delivery, and that has to start now.