A good overview on the challenges and opportunities for Canadian healthcare by André Picard of the Globe. Following quote captures how the challenge has changed.
In 1957 – when the program became nominally national – the average age of Canadians was 27. Health care consisted of acute, episodic care: going to the doctor for treatment of an infectious disease, or to the hospital to give birth, have surgery or die.
Today, the average age of Canadians is 47. The technological advances of the past half century have been dizzying. The vast majority of our care needs are now for treatment of chronic illnesses.
Neither the model for delivering care nor the insurance payment model has adapted to the new reality. You can’t deliver modern health care with a 1950s model.
With respect to the choices that need to be made:
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.
Of course, the devil is in the details given the complexity of healthcare, the wide range of players and stakeholders, and the difficult politics, but a good thoughtful piece.