February 23, 2024

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Experts release 13-step roadmap to reform Canada’s health-care system


Don Drummond has spent 46 years working in the field of public policy and he says he’s learned a key lesson during his career — timing is everything.


So, given the lingering effects of the COVID-19 pandemic and the widespread frustration Canadians have with the health-care system today, Drummond says he’s hopeful that a new roadmap for reforming the system, which he co-authored, will inspire both short-term and long-term changes to how healthcare is delivered and accessed in the country.


“I don’t know if this is the best time there will ever be, but this is the best time that there has been over the last 46 years.,” Drummond, a Stauffer-Dunning Fellow and professor at the School of Policy Studies at Queen’s University, told CTVNews.ca in a phone interview.


“And it sounds kind of crude, but people are speaking up and we needed people to speak up.”


Released by the C.D. Howe Institute Thursday, the roadmap features a 13-step plan to reform the health-care system and reflects the input of 23 expert reviewers — Health Canada being one of them.


Top of the list is a recommendation to do better data collection, analysis and reporting. The experts say this should involve greater consistency under a federal approach to provincial and territorial health data, rapid expansion and use of fast-advancing technologies like AI, as well as measures of health outcomes and population health status.


Another recommendation is to implement more team-based health service models. Drummond says this would shift away from the traditional model of having a lone primary physician tend to most needs of patients to having a variety of health-care workers, including nurse practitioners, registered nurses and pharmacists, sharing patient care responsibilities.


“Why send somebody to a physician, probably with difficult access and a long wait time to deal with that, when the pharmacist could deal with that, or a nurse practitioner could deal with that?” he explains.


“(It’s) lower cost, we could have more of them and we could have faster access.”


The experts are also pushing for better health workforce planning and call such planning “acute,” especially since there is a dwindling number of Canadian-trained medical students and graduates choosing to specialize as family doctors, which could lead to even worse access problems to primary care if nothing is done to address the issue.


Some actions that could be taken include giving priority in university admissions to those committed to specialize in family medicine, shortening the program to qualification and offering fee rebates to students, the roadmap notes.


Improving the pay and working conditions of family doctors is another measure the experts say could be taken to make the profession more attractive to prospective medical school students.


The roadmap further recommends redefining long-term care to encompass a continuum including home care and community based living.


Drummond says there is going to be a doubling of the 75 and older population in Canada in the next 20 years, but there is very little attention being placed on what can be done to better care for seniors in the country.


He notes that even though the majority of COVID-19 deaths in Canada occurred in long-term care facilities, politicians have responded by building more long-term care beds as opposed to building more homecare and community-based living supports, which many seniors prefer.


“We seem to be just marching into this so-called solution where we’ll institutionalize people in long-term care facilities, and yet, nobody ever stands up and says that’s what they want to do and where they want to go,” Drummond says.


“That’s not the best solution and it’s not what people want, and it’s a higher cost solution as well. So in this case, a home based care solution is a win-win because it’s what people want. And there are lower costs and other countries have done it.”


The roadmap also examines why previous attempts to change the governance, management, structure, function and accountability of health services have been unsuccessful.


As Drummond puts it, previous health-care reform attempts have focused on reducing costs, a measure that incites fear in Canadians who pride themselves in having a public health-care system. That’s why he says the experts decided to focus less on the financial aspect of reforming care and more on the challenges in the health-care system and possible solutions.


“Let’s just concentrate on the stuff that can and should be done right away that will make a big impact,” he says.


In a statement to CTVNews.ca, the office of Health Minister Jean Yves-Duclos says “Canadians are rightfully concerned, and so are we,” adding “no one should lose a loved one because they couldn’t get timely medical attention.”


The office says the federal government is continuing to work with provinces, territories and various stakeholders to deliver better health-care for all Canadians, noting as part of its 2023 budget, the government is investing close to $200 billion over 10 years “to address pressures on the health-care systems,” especially in pediatric hospitals, emergency rooms and long wait times for surgeries.


“We know that money alone will not solve all these issues, but our collaborative plan with provinces and territories is focused on delivering real results for Canadians,” the statement from the federal health minister’s office reads.


“With our plan, we can ensure they get the accessible, high-quality and safe care they deserve when and where they need it.”  


The roadmap was also co-authored by Duncan Sinclair, professor emeritus of physiology at Queen’s University, Dr. David Walker, emergency medicine and policy studies professor at Queen’s, and David Jones, a policy analyst and economist studying at the Munk School of Global Affairs & Public Policy.


The entire roadmap and list of recommendations can be viewed online.


Health Canada did not respond to a request for comment prior to publication.