Is the health care system working for you ...and what are your expectations looking ahead?

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Introduction

For many Canadians this country's the health care system has become one of the things that defines us, and any talk about changing it is often met by many of us with great apprehension and by some with great suspicion. Well, as the new year dawns it is certain to become a major topic of conversation in the months ahead. Last month provincial, territorial and federal health ministers met ...and later the finance ministers too. The major topic at each meeting: how to proceed with health care.

You might recall the health care summit in 2004 when Paul Martin was prime minister. The accord that came out of that meeting was billed as an agreement to 'fix health care for a generation.' In fact it provided for a $40-billion dollar injection over 10 years to reduce waiting lists and improve Canadians access to health services with five major priorities: cancer, heart disease, MRIs and other diagnostic imaging, hip and knee replacements, and cataract surgery. That agreement expires in two years and the provincial and federal governments are already making plans for what happens then.

Finance Minster Jim Flaherty surprised everyone two weeks ago by announcing a new and non-negotiable formula for federal funding of the provincial health systems. The proposed formula calls for six percent annual increases in federal health care transfers to the provinces until 2017. After that, increases will only be tied to economic growth including inflation - roughly four per cent - but will not fall below three per cent per year. Some observers say it's a way to get the funding issue off the table and start working on ways to give Canadians the health care services they need, more efficiently and with more accountability than how it's being done now.

Many experts and a growing number of Canadian health consumers have sounded the alarm about the way in which spiraling health costs are eating up greater and greater portions of government budgets. Canada has one of the richest systems in the world but not neccessarily the best when it comes to taking care of Canadians. An impending "Boomer Tsunami" plus new needs are changing the priorities of what Canadians want from their health care system.

As a front line physician working in an urban Emergency Department, I've seen first hand the relentless growth in the demand by Canadians for health care. I've seen many of the challenges up close - from the growing number of people who come to the ER because they don't have a family doctor or nurse practitioner to look after them ...to the yawning need for timely access to specialists in neuro- and plastic surgery. As a medical broadcaster and host of White Coat, Black Art, I've toured the county and seen many successful health care innvovations that could -- if the will is there -- work in other parts of Canada too. I've also seen how new technology can improve both health care and the way it's delivered.

Homecare, pharmacare, longterm care, patient-centred care and preventative care are just a few of the buzzwords now increasingly being used. How are these needs going to be folded into the system of the future?

Some experts are suggesting nothing short of a remake in each province is what is needed. What do you think?

Today we want to hear from Canadians ...from you ...about your views on the health care system. How has it served you to this point? Give us the good and the bad. Are there ways health care could be organized differently?

What services would you like to see in the future? Are you prepared to see changes to the way health care is delivered to guarantee a strong and healthy system in the years to come ...and as Canada's population ages?

On New Years Day we're going to review the very thing that constantly appears near or at the top of Canadians' political priority list ...the health care system. How has it been doing ...and how do you want it to change to meet the needs of the future?

Our question today: "How well is Canada's health care system working for you ...and what are your expectations looking ahead?"

I'm Brian Goldman ...on CBC Radio One ...and on Sirius satellite radio channel 159 ...this is Cross Country Checkup.

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Guests

• André Picard
  Public health reporter and columnist for the Globe and Mail.
  
  
• Dr.Michael Damus
  Chief of Staff Uxbridge Hospital, Ontario.
  
  
• Pauline Worsfold
  Secretary-treasurer of the Canadian Federation of Nurses and a recovery room nurse at University of Alberta Hospital in Edmonton.
  
  
• Steven Lewis
  Health policy analyst and President Access Consulting Ltd. Saskatoon and Adjunct Professor of Health Policy at the University of Calgary and Simon Fraser University.
  
  
• Dr. Susan Brien
  Neuro-surgeon and Chief of Trauma at Gatineau Hospital, and Registrar and Associate Director of Professional affairs at Royal College of Physicians and Surgeons of Canada, and researcher into surgical simulators.

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Links

CBC.ca

• Premiers split over Flaherty health-funding bombshell
• David Alward rebukes Ottawa over health plan

National Post

• Editorial: Flaherty's smart move on health funding
• Growing out of our health-care myths, by Lorne Gunter

Ottawa Citizen

• Health reform: Harper tells provinces to make do with less
• Finance ministers talk health-care funding in B.C
• Feds slowing rate of growth in health care transfers
• Ottawa may begin cutting back health-transfer payments in 2017
• Editorial: A present for the premiers
• Paul Martin blames Tories for lack of progress on heath-care reform

Globe and Mail

• Ottawa's surprise health-care offer is a good one
• In Ottawa, health-care funding hits the wall
• Unilateral pronouncements won't help us all get along, by André Juneau
• In surprise move, Flaherty lays out health-spending plans till 2024
• Can community care take pressure off hospitals?
• With funding set, Health Minister reaches out to provinces on reform, by John Ibbitson
• Ottawa's offer and the provinces' health challenge, by Jeffrey Simpson
• Health-care efficiency seen as more critical than funds, survey finds
• Shrewd tactics not the same as good health policy, by André Picard
• Dwight Duncan sheds crocodile tears over health-care cash, by Tim Powers
• Provinces get more autonomy to drive health-care reform

Sun News

• Health accord: A small step in the right direction, by Jason Clemens And Brian Lee Crowley
• Ottawa's health care handoff, by Craig McInnes
• Flaherty exits boldly from one fine mess 39, by David Akin
• Ont., Que. need to fix health system or feel the pain: Expert

Toronto Star

• Editorial: Ottawa backs off on health
• 6 per cent solution for better health care, by Armine Yalnizyan
• Why the Harper funding diktat endangers medicare, by Thomas Walkom

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E-mail

I think health care dollars would go farther if this "insurance" system reflected risk in the way that other insurers assess it. For example, tobacco taxes aside, I don't feel so great about caring financially for those who are sick because, at some crazy moment in their lives, they have chosen to become addicted to cigarettes. I don't feel that great about subsidizing those who choose not to wear a bicycle helmet, wear seat belts or have injured themselves in non-essential activities like bungie jumping and other extreme sports and activities. Even some activities like skiing on snow or water are choices which add a level of risk to insuring someone's health.
 
Thomas Brawn
Ottawa, Ontario

 

Like many Canadians, my view of our health care system is coloured strongly by the experiences of my U.S. relatives. I am so grateful for our system, and full of pity for family and friends who pay double the cost for half the care (or no care at all.)

In comparison with some of the European systems, we could do quite a lot better. But I hate to criticize our system because of the North American corporate and political pressure to push our health system, prison system, and banking system closer to the models which have failed so disastrously south of the border.

If I knew Canada would make changes moving us in line with the best systems in the world I'd be happy to make suggestions, but with the current federal majority I am certain that would not happen.

Holly Nelson
Winnipeg, Manitoba

 

The biggest concern regarding health care should be that most medical research, and hence the direction of that research, is left in the hands of the pharmaceutical industry. Another concern is pharmaceutical advertising. I would rather you didn't use my name, since I am a pharmacist who needs to work!

John D.
Hamilton, Ontario

 

My nearly 92 year-old mother is waiting for a hip reversal, which is to remove and replace an artificial hip that she received some 15 years or so ago. The hip has been dislocated since July so she is suffering with terrific pain whenever she goes from sitting to standing to wheelchair, walker etc. My attempts to speed things up are to no avail and my heart goes out to her every time I see her continued efforts to remain independent. If this is the best we can do I say it is not, by a long stretch, satisfactory.
 
Thank you for a great show.
 
Mary Dancy
Duncan, British Columbia

 

I continue to be disappointed that alternative health care is not included in our system. As a recipient of nasty drugs in cancer treatment that were not helpful, I turned to acupuncture that has given me much energy. What does Dr. Goldman think of including acupuncture by others than physiotherapists or massage therapist?

Our system is so contolled by big pharma that nothing else is tolerated. I would like to see acupuncture, massage and healing therapies such as Reiki, healing touch, etc. promoted as a key to wellness and support.

Insurance companies and provincial health insurance will only tolerate physician-approved prescriptions. They are so restrictive in how many treatments might be had. And that leaves no responsibililty to the individual to decide what is helpful for them.

Helena Robb
Orleans, Ontario

 

It is always astonishing to me that no one on these health care programs points out that it is indeed the vested interests that are the problem, as your guest mentioned today. Specifically, I believe it is the medical profession's great reliance on pharmaceuticals that is a big part of the problem. When we become ill it is most often the fault of life style like poor nutrition, lack of exercise and habits of over indulgence.  Those of us who don't want to use drugs unless they are the last resort go to naturopaths, homeopaths and chiropractors.

A friend who is a retired nurse told me that it was a relief to be retired because as a nurse she was often required to give medications that she could tell did nothing for the patient. Nurses are much more capable than they are allowed to be. We need more nurse practitioners who are closer to the patients and are often more aware of patients needs. The emotional needs of patients also need to be considered.

Doctors need more education in lifestyle, nutrition and all the things that people themselves can do everyday. Schools need to provide more education in lifestyle for students so they understand that health is their responsibility. We need more suport for home care for all ages.

Such education might create more short term expense but lower costs in the long term.

Judy Earl
Vancouver, British Columbia

 

I think it is easy to see the salaries of doctors and nurses as the biggest expense to health care. I retired after four decades as an RN Registered Nurse). I saw the complexity and acuity of care rise beyond belief, and the levels of management grow in mammoth numbers. These people spend enormous amounts of time in meetings that are of dubious end result but assure their significant salaries are maintained as the trend is to cut in the trenches, brow beat those who take a sick day and hector them to return to work on days off or to work overtime. Using up the minds and bodies of our health care professionals will have much greater impact on maintaining services which, too often, are on the backs of the front line.

Patricia Findlay
Vernon, British Columbia

 

I have been working as a nurse since 1979, both in hospitals and the community. I agree with your speaker, Andre Picard, that there are sufficient funds but management of these funds are poorly done. I find it disgusting how we have elaborate foyers in hospitals and yet hospitals are not patient friendly. Patients are forced to walk extensivelly to areas of the hospital even if they are unable to do so independently. I have noted many hospitals are top heavy in management and the wages of CEOs are unreasonable high.

I work in a diabetes centre. The people who are really needing extra funding are those who have a limited income and yet do not meet the requirements of present provincial drug programs. I worry about people with Type 1 diabetes who do not have social support and cannot afford insulin. There is not enough funding for social workers. People who have psyciatric disorders have few places to go. These people end up in the ER on a regular basis. They are at high risk for diabetes-related complications.

The return of social support housing for psyciatric patients would provide stability.  Increased funding for social workers and psychologists would help people with chronic illnesses such as diabetes. Funding to provide insulin for people with Type 1 would eliminate their desperation for basic hormones they need to live.

Marian Barltrop
Port Perry, Ontario

 

Personally, I have no complaints. While basically healthy, I did have issues with atrial fibrillation that worsened over the past year, leading me to have various tests, medications and trips to emergency resulting in cardioversion to revert back to normal rhythm, and ultimately having pulmonary vein ablation (within my heart) in July. So I utilized many aspects of our health care system including physicians, nurses, respiratory techs, meds and various technological materials and equipment and I didn't have to go into debt.

Professionally, I am a retired RN and worked several years in middle management and as a head nurse on a very busy surgical unit. One of my responsibilities in this role was to replace equipment as necessary and, at times, evaluate new equipment brought in prior to purchase. I think this is one topic that needs to be studied in terms of health costs.

The cost to order a regular stool for a nursing station (without wheels) is $90.00. Yet I purchased a similar stool for my own home from a local store and paid $18.00. Similarly, a neighbor worked for a medical gas company and told me that a tank of oxygen for a welding company cost one price, and the same oxygen tank for hospital use was triple the cost. Granted this was 15 years ago, however, I find it hard to believer that this overcharging for medical purchasers has changed much.

Hospital and heath region purchasers have got to create a more competitive enviornment with the various medical supply companies. Other than that, I don't really know how to reduce those overcharges.

Thank you for this opportunity.

Joy Patrick
Nanaimo,British Columbia

 

I am hearing frequently that preventive care will help the health care system. I do agree that it decreases health issues if practiced very well for a time, but ultimately we all die. As I recall from my training, the statistics show that the last six months of our lives is the most expensive for our health care costs. That may occur later with good lifestyle choices, but ultimately the same result occurs. Does this really save money?

Gordon E. Riddle
Bracebridge, Ontario

 

One area of the recent health care funding reforms that doesn't seem to have attracted much notice is that the emphasis on provincial responsibility will exacerbate the structure of several disconnected smaller systems, rather than one larger federal one, and therefore make them smaller, easier targets for US-style HMO's to pick off one by one. With Mr. Harper's propensity to favour the American way, this is a subtle drift we should be very wary of.

Paul Brown
Markham, Ontario

 

Hi Brian,

Related to today's Cross Country Checkup, I would like to point out a hazard of the federally mandated wait times for specific procedures, that being neglecting other procedures that could be causing even more harm than those earmarked.

I speak from experience as a glaucoma sub-specialised ophthalmologist in Vancouver. I perform all my glaucoma surgery at a dedicated Eye Care Centre that is part of the Vancouver Coastal Health region. I share the operating resources with mostly cataract surgeons. Cataracts are a treatable cause of visual loss that causes no permanent harm if delayed. Glaucoma is a progressive form of blindness that needs to be treated to keep it from progressing as delays cause permanent damage. However, cataract surgery is mandated to have a short wait list as part of a federal initiative, and glaucoma surgery is not. So, since our operating room runs the risk of being fined if the cataract benchmark is not reached, cataract surgery, which can safely be delayed, takes priority over glaucoma surgery which is harmful if delayed.

I am sure this is only one example of many in which earmarking some common procedures for shortened wait times is causing more harm than good.

Dr. Robert Schertzer
Vancouver, British Columbia

 

There is much talk about money but little about its function. It is not only to cover the cost of services but also to steer patients towards a better use of the services. In insurance, the co-payment (i.e. the deductible from an automobile or fire insurance benefit) serves that function, although not as well as would be done by an explicit price or fee for service.  Why do we not have this also in health care? We do, if one counts dental insurance as health insurance.

In the many international comparisons, it would be interesting to hear whether or not those countries that spend less for a better service have or do not have an insurance subject to co-payments. The results of such a comparison may be revealing.

Sylvester Damus
Ottawa, Ontario

 

It is working good for me so far. The system is available for me, providing that I make an appointment ahead. I do not have any major problem with my health so far. I could not afford it if I had to pay for it out of my pocket.

Bill Davies
Bella Coola, British Columbia

 

Hello Dr. Goldman,

I don't see the envelope of public health care monies expanding looking forward. I also know that Canadians need to understand that even a publicly funded system doesn't mean that all our health care costs will be covered. With an aging population and more chronic care needs, more Canadians are going to be paying the costs of getting care for themselves or a loved one during a lengthy illness. Rex Murphy in the Nov. 27 program said that many patients are now looking at 12-year windows of care.

My question is how are we supporting our caregivers? As is widely known, most caregivers are family members or loved ones. My experience is that caregiving dont't get any kind of support looking after their loved ones.
 
Doctors often have little input to provide for family members about meeting the day to day needs of a chronically ill person. As a family that has been the only caregiver for an elderly family member with moderately advanced dementia for eight years, we feel we have no support in managing her needs. She lives in a retirement home as she doesn't qualify for long term care. That means we have to coordinate all her medical care and her day-to-day decision making. In addition, my husband is responsible for managing all her financial and legal needs. As her paranoia and delusions have increased, my husband has become the only person who can connect with her. There is a community based nurse in the home she lives in but no direction has been given as she progresses through the many stages and phases of her illness. She is currently 91 and has not been able to leave the retirement home she lives in for eight years expect for medical appointments.

For our family and for him, it has been a huge responsibility. My husband and I both work and we are raising a daughter who has gone most of the way through the school system while we have been caring for her. We need to pay for our duaghter's education so cutting back on our work responsibilities hasn't been possible. We have had to make many other sacrifices in terms of travelling and spending time with other family members.
 
The lack of accountability in the system and patients that are sicker with more complex needs means caregivers have to be doing more. Can the health care system afford to ignore the needs of caregivers? I think caregivers need more training and support to care for our loved ones and help them live their lives with dignity.

Heather Tremble
Oakville, Ontario

 

My son needed skull surgery at age seven months. While it was stressful, it all turned out well. The surgeon, anesthesiologist, nurse practitioner and nurses were all competent and kind. Our family is grateful for such wonderful care available to us as part of a publicly funded system.

What I would like to see change is birth services. I am president of a midwifery consumer group. Outcomes for babies and mothers are excellent under midwifery care. Their services seem well integrated in B.C. and Ontario but we have a long way to go in the rest of Canada.

Monica Eggink
Edmonton, Alberta

 

Hi,

I have a schizo-affective disorder. I have been in situations, moving around for work and school, where I cross provinces. The problem is that once I am in a province, and I receive medication coverage, then I move to another province; then the previous province assumes immediately that I have coverage in the new province. This is not immediately true. So there is a disconnect between provinces. I have had to borrow money for my medications, which are critical to my mental health. This is not a good situation. Thank you.

Gregory Mohammed

My mum just recovered from a sucker punch of bacterial pneumonia in early December that sent her to an emergency room in a Victoria hospital in medical distress. She received top-notch care from the moment she arrived and rapidly got better due to great nursing support. That was a huge improvement from her last visit six years ago at the same hospital that was depressing and the care indifferent. This time, we even received a 'client' survey after she came home from the hospital to evaluate the level of service and where they needed to improve. I think this is great!

For the future, as I sat during those terrible hours beside my mother's bedside in emergency, I was struck by the number of elderly patients with alzheimers lying in the hallway with various injuries due to falls. There has to be a better way.

Margot Cutcher
Victoria, British Columbia

 

The money allocated for health care is part of the overall spending priorities of government. Since Harper's priorities include lavishing billions on prisons, fighter jets and (as of today) yet more corporate tax cuts, this negatively affects money allocated to health care which should be, but is not, a top priority. This government is foolish in the extreme through wasteful spending.

Mark Fornataro
Victoria, British Columbia

 

I would like to see the health care system focus on health and wellness rather than on illness while, of course, taking care of the sick. Until it does it will be of no use, except in extreme emergencies, to we Canadians who have taken full responsibility for regaining our health and maintaining it.

I write as a 75-year-old woman who, after many years of illness and experience with the illness-care system, took matters into my own hands. For the past 25 years, I have enjoyed the kind of health and wellness that so many of us would be capable of if more attention were paid to what it takes to be well. To do this, I consult when needed and at my expense, with non-medical health care professionals who support my endeavours and understand that illnesses and symptoms serve to notify us that something is out of whack, be it diet, stress or other life-style factors that we can do a lot about before resorting to pharmaceutical and surgical masking of symptoms.

Beverley Viljakainen
Priceville, Ontario

 

Dear Dr. Goldman,

Any discussion of health care or health reform has to include the idea of health equity.
There is strong evidence that our health in Canada depends on our incomes, gender and race. Those with higher incomes are healthier and live longer. Any reforms should reduce rather than increases this unfairness and inequality in the health of Canadians

Sheila Block
Toronto, Ontario

 

I was hesitant to call into the Cross Canada checkup show on Canada's health care system.  I'm not that comfortable on the radio and would ask that my name not be used for privacy purposes. I'm very thankful to have a venue to express my own expereince with the health care system. I wish there were more patients who spoke up on this show versus health care providers so as to achieve a balanced view of what is occuring in our system today. I have a chronic illness (familial Crohns/Colitis for over twenty years) which  recently required surgery to correct and cure, yes cure, the disease. I have not asked for much of the system up to this point, an occassional visit to my GP and once a year colonoscopy because of familial colon cancer. Also prescription drugs for disease flares, usually anti-inflamatories. I pay three ways into this health care system, via things which are not covered, via my work health care plan and via my taxes.

Everything changed three years ago when my disease flared and did not subside. I've been through three years of intense drug therapy with no change, hence the surgery. What I discovered through this experience was a mainly acute care system frought with inconsistencies and virtually no accountability to the patient or seemingly no apparent oversight of the care givers (nurses, doctors and administrators) with the exception of following how much money is saved. In essence my issues are with the lack of basic fairness and accountability within the existing acute care system.

Not every chronically ill crohns/colitis patient is given the same basic quality of care, in the doctors office, on the hospital ward and by having access to basic health care aides such as drugs. We have a failed patch work system across this country with regard to access to specialists, basic diagnostic procedures, medications to name a few. I've also found the nurses, doctors and administrators are the gatekeepers who do not account to the patient as to why they are not receiving the same level or quality of care versus others. If the only benchmark for success in our current system is cost savings we are failing miserably. We need basic standards for accountability to patients and otherwise as well as standards of care accross this country. With our current government, we are in jeopardy of losing what works in this failed system, a semblance of equity in funding of acute care and the minimum standards outlined under the Canada Health Act.

Thank you,

D.M.
Winnipeg, Manitoba

 

Dr. Goldman's emphasis on listening and keeping comments to a minimum makes for a calm, listenable program. Thanks!

Elaine Perry
Vancouver, British Columbia

 

Dr. Brian Goldman,

Canadians find there is still an extreme shortage of physicians. One of your guests said we have increased the number of students in medical schools, he did not mention that the size of classes were drastically cut over 20 years ago because somehow someone decided we would have too many doctors if they did not. We have also lost a lot of Canadian-trained doctors to the U.S., and retirement of the baby boomer doctors all add up to not enough doctors.

We have a lot of excellent Canadians studying medicine abroad. For these students coming home is often difficult. They apply through CARMS for a residency position but are told there are not a lot of residency positions available. It seems to me that Canada could take advantage of this. These students have already paid for their training, have not taken additional places in the Canadian schools. Why not welcome these Canadians back, put them into a residency programs crated for Canadian medical students trained abroad, their English is excellent and they want to come home and stay. They would probably even sign an agreement to stay in a rural area after their residency.

Deborah Wagner
Brechin, Ontario

 

I spent $3,000 on MRI scans that were terrilby incorrect. Ignoring them, I found I had a shifted Atlas, from a speaciality chiropractor. One leverage and 12 years of stabbing occipital pains were gone. I have seen four neurosuergons and they just ignored me. There is a problem with our system when hard to diagnose problems can be sidestepped.

Andrew Ladd
Armstrong, British Columbia