Janice Kopinak is a member of GuelphToday's Community Editorial Board
Headlines pertaining to Canada’s healthcare system frequently point to a simple causal connection between access of quality care, and financial input as the only answer to ‘fixing’ a system that is complex, fluid and requires constant vigilance.
Challenges to health care prior to the pandemic included long waits for elected surgeries, overwhelmed emergency facilities, fatigued staff, and lack of available beds. These challenges surged over the course of the pandemic and are now magnified as health care plays ‘catch-up’ while simultaneously struggling with variants of respiratory viruses and an aging population.
The answer to mitigating these challenges does not lie only in increased public spending but better management of the funds available. To fully recognize how these challenges impact on health care, it is important to understand Canada’s Health Care Act and how the principles apply at the local level.
The first universal health care Act in 1966 was followed by the current Canada Health Act (1984) which is built on five principles; non profit (publicly administered), comprehensive (medically necessary care), universal (available to all), portability (out of Province/country), accessibility (equitable access). Though enshrined in Federal Law, the Act is administered by the provinces and territories which in turn finance health care at the local level.
This op ed suggests strategies that could mitigate the most pressing challenges locally; funding (equity and equality) and access to qualified primary health providers.
Many beneficiaries who wait for hours to receive services in overcrowded emergency rooms could be treated more efficiently in community health clinics. In a recent review carried out in 2020-21 the findings were that the majority (61.4) of Emergency Department (ED) visits were non-urgent and represented a burden better managed by primary healthcare providers.
Community health clinics (CHC) open 24/7 and staffed by nurses, nurse practitioners, physicians, and other allied health professionals can provide primary accessible and efficient care. The emergency department at GGH estimates that 13 to 15 per cent of visits could be handled in the community if there were well staffed facilities open to the public around the clock.
This investment at the local level would relieve the pressure on emergency rooms throughout Guelph-Wellington (GW) with astronomical savings to the public purse. The few CHC in GW do not meet community need with hours that are not conducive to easy access by the public.
Nurse practitioners carry out a large part of what a general practice physician does in a primary health care/community context. They have the knowledge to diagnose and treat various mental and physical health ailments, order diagnostic tests, and refer to a specialist or a hospital when necessary.
Nurse practitioners are employed by hospitals and primary care clinics however Nurse Practitioner Led Clinics (NPLCs) is an innovative model for delivery of comprehensive primary health care designed to improve access to care for the many individuals and families who do not currently have a primary health care provider.
NPLCs provides leadership at all levels of patient care delivery, are non-profit and a key component of Ontario’s health care strategy to reduce the number of patients who do not have a primary care provider. There is no doubt that increasing the number of nurse practitioners at the local health care level would increase accessibility to quality care and budgetary savings..
The population/public health mandate is to improve the health of Canadians through interventions based on disease prevention, health promotion and protection.
The focus is on factors that influence health over the life course and identification of patterns of disease occurrence including outbreaks, epidemics and pandemics, the latter demonstrated by the Guelph-Wellington-Dufferin Public Health unit in the recent pandemic. Public Health has an excellent website that lists the myriad of services aimed at maintaining public holistic health (biological, mental, social). However, the largest amount of funding still goes to hospitals rather than preventive services which have experienced drastic cuts in recent years. This includes generous private donors and organizations who might consider financing a community health or nurse practitioner clinic. It is important to stress the importance of these investments to local donors.
Keeping people at home with support has proven to be not only a cost saving measure but a humane one for elders and the physically/mentally challenged who do poorly when hospitalized. However, more needs to be done to compensate community personal support workers (PSWs) to carry out their supportive role.
Unfortunately, for-profit agencies and/public/private partnerships contract out these valuable health care support personnel at great profit PSWs working in the community earn less than fair salaries and endure poor working conditions. The result is a constant shortage of staff that impacts on care and places beneficiaries at risk of poorer health. To ensure that vulnerable citizens have access to quality care within their homes, these valuable service providers need to be adequately compensated at the financial and workplace levels.
The recent influx of federal funds to the provinces and territories for health care follows a well-worn path proving that increasing financial transfers to mitigate challenges have failed to lead to sustainable solutions in the past and is unlikely to do so in the present and future.
The funding generally leads to a patchwork of ‘new incentives’ which rarely last when new Governments are elected. Close to 60 per cent of the total health budget is spent on hospitals and physicians’ compensation.
What remains is distributed among a plethora of services including public health, community and cancer care, mental health and addictions, LTC, emergency services, technology and administration. Of utmost importance is to understand that while doctors are a crucial service, so are the other team members that make up the ‘health care system’ which includes both hospital and community care. Resources, whether municipal or private need to reallocate local resources in a fairer, more equitable and efficient way for all health care providers that provide quality care GW beneficiaries.
Questions pertaining to the gaps in our local health care system that negatively affect equity and quality for those who contribute to the public purse through taxes remains.
The lofty principles of the Canada Health Act are what most Guelph-Wellington citizens want to maintain, however to do so is going to take a lot of courage on the part of our municipal government and other stakeholders to manage public funds more effectively, while following the Canada Health Act principles without exception.
This is what was promised to Canadians, this is what Canadians pay for and this is what Canadians have a right to expect.
