Federal open letter: Transform public health care with public solutions
In 2020, our health care system and the professionals that constitute it were hailed as heroes for the remarkable adaptations that were made to an unknown and evolving novel virus. Canadians heeded advice to seek care only in emergency situations, and collectively, hospitals weathered the pandemic’s early storms.
However, many parts of our health care system did not fare as well, especially long-term care. Now that chronic health needs have grown exponentially, Canadians are being confronted with a health care system and workforce facing unprecedented strain.
One significant strength of universal health systems is the ability to co-ordinate the most appropriate patient care, at the right time and in the right place. Yet, our health system underutilizes this advantage. Though the scale of the current health system crisis is new, existing solutions that leverage this advantage are well-established and well-studied.
As physicians and trainees, we are writing to you in support of five paths for reform proposed by Canadian Doctors for Medicare:
(1) Team-Based Primary Care,
(3) Single-Entry Specialist Referrals
(4) Home Care
(5) Health Human Resource Planning
Team-Based Primary Care: Health care systems built on robust primary care have better outcomes, lower costs and better equity. Everyone in Canada needs a relationship not just with a single family physician, but with a primary care team, or patient-centered medical home. Team-based primary care allows patients to access multiple professionals like nurses, dieticians, and physiotherapists to more comprehensively address their health care needs. Though some in Canada are fortunate to be cared for in this way, access to these models of care is scattered and in short supply. Further exacerbating this shortage is that many of the hardest hit communities during the pandemic, have the worst access to these teams.
Pharmacare: Despite the federal Supply and Confidence agreement reached between the federal Liberals and NDP, there have been few signs of progress on a universal, public plan. This is concerning given their commitments to introduce legislation before the end of 2023 – a deadline that is rapidly approaching. This stalled progress comes amidst decades of research that show such a plan will improve patient outcomes, reduce health care costs and enhance health system sustainability.
Single-Entry Specialist Referrals: Most specialist referrals in Canada are made directly between individual family physicians and individual specialists. This results in unnecessarily prolonged waits for patients. A single-entry referral model creates a single pathway that directs each patient to the next available provider based on urgency of care. When responsibilities for evaluating and treating patients are shared by a cooperative group of providers, like a surgeon and physiotherapist, patients receive both faster and higher-quality care.
Home Care: Nearly 100% of older Canadians want to receive care in their own homes for as long as possible, and avoid institutionalization in long-term care. Yet compared to several other OECD countries, such as Denmark, Canada’s total per capita continuing care spending- which includes spending on home care and long-term care institutions- falls significantly short. In addition, Canada spends proportionately less on home care and more on long-term care. Correcting this underfunding and misallocation, along with developing and legislating national standards for public home care, should be a top priority at this time.
Health Human Resource Planning: Currently, each of Canada’s 13 provinces and territories have a unique set of physician licensing requirements and fees. Physicians are often called upon to work across jurisdictions to fill gaps in coverage, most notably in rural areas. Shifting to a pan-Canadian licensure instead would help to reduce many of the barriers associated with these care gaps.
In the long-term, Canada should take a proactive approach to health human resource planning by creating evidence-based models to better predict the number and type of health care professionals we need. Using population demographic information to anticipate the future health needs of Canadians can ensure we have enough time to adjust our health professional training pathways (i.e. residency programs) to better suit patients’ needs.
We recognize that the scale of each these proposals vary, as does the level of collaboration required across jurisdictions. Some proposals can be implemented sooner than others, but work on all can be advanced now. We also recognize the totality of health system reform that must also be undertaken includes many other domains.
We would welcome the opportunity to meet to discuss how to better advance these proposals for change, and facilitate co-operation between federal and provincial/territorial leaders.