Thursday, 31 May 2012

Medicare in the 21st Century - Change is Afoot!

On May 23, I was lucky enough to hear Andre Picard speak.  He's the health and social policy writer for the Globe and Mail newspaper, but he's much more than just a good journalist.  Picard is the 2012  CIBC Scholar-in-Residence Chair at the Conference Board of Canada.  Picard chose to speak on "The Path to Healthcare Reform: Policy and Politics".  You can listen to his address here and there's a shorter print version in the Globe here.

Let me offer my two cents worth on Picard's ideas and first, allow me to come clean - I agree with everything he says.  Here's a snippet of his proposals for overhauling Canadian healthcare:


Canadians have to accept that public health insurance covers only the basics. At the same time, those who oversee the system have to recognize that physician and hospital care is not sufficient in the 21st century.
We need to expand the areas medicare covers – into drugs, homecare, long-term care – while at the same time limiting coverage across the board to the essentials.
Universal coverage is not a synonym for unlimited, open-ended coverage. There are choices to be made. They include:
•As stated already, defining clearly what is covered by medicare and what is not;
•Paying only for what works: There are a lot of interventions that are of dubious value or that are not cost-effective. They shouldn’t be covered by public insurance;
•Paying a lot more attention to patients with complex needs because they drive costs. One per cent of patients account for 25 per cent of costs, and 5 per cent account for half of all spending;
•Instituting a means test: An equitable system does not mean you have to provide equal services to all at equal cost; user fees and co-payments are not necessarily unfair, but these approaches have to be used smartly;
•Regulating rather than outlawing private insurance and care. One of the most important lessons we have to take from Europeans is that we need a combination of a well-regulated private system and a well-managed public system.
In my book, "The Four Walls of My Freedom", I wrote: "In Canada, health, social care and education are matters under provincial jurisdiction.  My family experience has been in the province of Ontario, but federal guidelines are such that, in principle at least, there shouldn't be too much difference in standards of decent support across the country.  In light of a proposed reinvented public/private partnership between government and families, what exactly should be the bottom-line expectation of provincial governments?  I believe "adequacy" is the correct response here.  Governments should ascertain what is required to support individuals' lower functioning (ie the essentials of basic health and survival).  This should include mobility equipment, nursing services as currently identified for medically complex care, such as patients on ventilators, and of course community-based residential care facilities for acute and long-term care patients."
I was thrilled to hear Picard opine that more attention should be paid to patients with complex needs because  "if we can get them right, mostly everything else will fall into place".  That sentiment captures perfectly the raison d'etre of my book - I wrote down our experience caring for Nicholas because I believe that we can offer lessons in how to care for vulnerable citizens more ethically and more economically.  
The lecture hall at Canada's National Gallery of Art was packed for Picard's lecture.  We were listening to a voice of change - now, are we willing to act?  I hope so.

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