Beyond funding, meaningful reform in health care needed

Zero. As a physician and a new Senator, I talk to patients about the current state of Canada’s health-care system. Zero patients, not even one, have expressed confidence in the current, or future, state of Canada’s cherished health-care system. And after 25 years of medical practice, I cannot agree more. Their responses range from “I am afraid to get sick and go to the hospital because I may not get the care I need,” to “the system is crumbling before my eyes.” Health care is complex and health-care reform has been described as a “wicked problem”—difficult to solve because of incomplete and changing requirements, and without any simple solutions. To start, Canada does not have a single national health-care system. Rather, we have 14 (10 provincials, three territorials, one federal) health insurance plans with varying benefits and approaches. Save for certain populations covered by federal health insurance (i.e., eligible First Nations and Inuit peoples, Canadian Armed Forces, resettled refugees and refugee claimants, inmates in federal penitentiaries), the financing, administration, and delivery of health care is primarily within the jurisdiction of the provinces and territories. Certainly, more health care funding is urgently required. But more than money, health care needs meaningful reform. And it needs political courage to think beyond short term fixes. So, what next? Work together. Redefine. Deliver better. Collaboration between the federal government and provinces and territories, across jurisdictional silos, is needed to provide Canadians with the health care they deserve and expect. In the darkest days of the COVID-19 pandemic, health care professionals worked together to save lives. Now it is time for our governments to do the same to save health care. The planned Feb. 7, 2023, first ministers' meeting with the prime minister is an encouraging step towards pan-Canadian solutions. It is expected that the discussions will include increases in funding as well as metrics to measure outcomes; this should come as no surprise as Canada is amongst the highest spenders on overall health care in the Organisation for Economic Co-Operation and Development (OECD) countries, yet Canada’s health-care system performance falls below the average OECD country. Health care reform should include redefining what constitutes a “medically necessary” health-care service, and hence what is covered by provincial and territorial health insurance plans. The Canada Health Act states that the primary objective of Canadian health-care policy is to “protect, promote and restore the physical and mental well-being of residents of Canada." Although there are plans for national dental care and pharmacare, other services that would “protect, promote and restore” the health of Canadians remain uninsured. For example, mental health is recognized as a fundamental component of health yet many mental health services, unless received in hospital or through a psychiatrist, are uninsured and must be paid for out-of-pocket or by private third-party insurance. And while there have been recent agreements to increase mental health funding, inequitable and inconsistent access to mental health services remains a problem across Canada. Finally, it is time to deliver better care through collaborative models that provide high quality, comprehensive health-care services. The federal government is currently working on a much-needed health human resource (HHR) strategy, but simply adding more people into a struggling system without changing care delivery models is akin to doing the same thing repeatedly and expecting different results. Burnout amongst health-care professionals is at an all-time high and contributes to staff shortages; providing mental health supports and solutions to heavy workloads and administrative burdens should be part of the HHR strategy. Investment in primary care is a common feature of top-performing health-care systems in OECD countries. The Patient’s Medical Home is a successful team-based care model where family physicians partner with other health-care professionals and integrate with social services and community supports; this model is currently used in locations across Canada and could be scaled up nationwide. This short list is by no means complete or comprehensive. But it comes from a health care professional who cares deeply about protecting Canada’s public health care system. On Feb. 7, 2023, we should all be watching. Senator Flordeliz (Gigi) Osler was appointed to the Senate of Canada in October 2022, as a representative of Manitoba with the Canadian Senators Group. She is an internationally renowned surgeon and a dedicated advocate for health and health care.