by Rosalee Longmoore and Teresa Neuman
Originally published in Briarpatch Magazine, February 2003. Reprinted with permission.
Roy Romanow, head of the Commission on the Future of Medicare, tabled his long awaited report, Building on Values, The Future of Health Care in Canada, on November 28, 2002. The report offers 47 recommendations that could reform the present Medicare system, including modernizing the Canada Health Act and creating a Canadian Health Covenant to reflect a new vision of Medicare.
The people of Saskatchewan have been leaders in implementing the vision of publicly funded Medicare. The City of Swift Current laid the foundation for Medicare in the 1940’s with the first public health insurance program, making health services available for all its residents regardless of their ability to pay. Provincial hospital insurance, introduced in 1947, and the first provincial public health care system, introduced in 1962, preceded the first national Medicare program with shared funding from the federal government. Although opposed by physicians and insurance companies, this plan realized Tommy Douglas’ dream of full access to physicians and hospitals for all Canadians.
Saskatchewan residents now watch and wait to see how the Prime Minister will implement the report and how health care in the province will be affected.
Romanow argues that the Medicare system has served Canadians well and is as sustainable as Canadians want it to be. He found that there is no evidence to support shifting the burden of funding from government to the individual. Romanow notes that as long as the system is prepared to change to meet needs and expectations, Canadians appear willing to pay more for health care. Effective governance is required to balance services, needs and resources.
Romanow states that the health care system must be transformed so that it focuses on primary care. Romanow believes that Canadians should have access to an integrated continuum of care no matter where they live, 24 hours a day, and recommends a Primary Health Transfer to move primary care out of the project phase. Believing that the health system is focused on sickness rather than prevention, Romanow recommends that programs be developed to encourage Canadians to stop smoking, lose weight, and live healthier lifestyles.
Romanow would see funding for Aboriginal health programs consolidated and used to support the creation of Aboriginal Health Partnerships to organize health services for Aboriginal peoples and promote Aboriginal health. This funding would further improve access for Aboriginal peoples to all levels of health services, recruit new Aboriginal health providers and increase training for non-Aboriginal health providers. Further, direct input into the AHP should come from the Aboriginal peoples themselves, to ensure that their needs and the needs of the community are being met.
Expanded Home Care services
Medical treatments are becoming more complicated. Patients are being released from hospital sooner, leaving part of the care to happen at home. Families act as unpaid caregivers assuming up to 80 percent of care, and individuals assume the costs of treatments and supplies. Romanow recommends that a new Home Care Transfer be used to ensure that all Canadians have access to essential Home Care services including home mental health case management, post-acute home care and palliative home care. He urges the development of programs organized under the umbrella of the Employment Insurance program and Health Canada to support informal caregivers.
Prescription drugs have become an important part of treatment as the burden of care shifts from facility to home. 300 million prescriptions are filled in Canada annually, or approximately ten prescriptions for each man, woman and child. Canadians spend an average of $1,210 per year on prescription drugs, with an average cost of $32.92 per prescription. In 2001, Saskatchewan residents filled 7,979,826 prescriptions alone!
Romanow recommends the integration of prescription drugs within Medicare and the creation of a Catastrophic Drug Transfer to eliminate the disparities in drug coverage between the provinces. He further recommends that a national drug formulary be established to equalize the costs of drugs between the provinces and ensure that Canadians have access to the same drugs no matter where they live in Canada.
Health Human Resources
The recommendations put forward by Romanow in his report may not happen if health human resources issues are not addressed urgently. Romanow acknowledges that quality of working life, in particular for nurses, is a serious concern and recommends that funding for training and retention be taken from the various proposed transfer funds including the Home Care transfer. Further, Romanow suggests that better efforts be made to collect data and report regularly on retention, recruitment and remuneration of health care providers.
Early in his dialogue with Canadians, Romanow invited those interested in privatization and de-listing health services to present evidence showing how these approaches might improve and strengthen the health care system. He found the proposed solutions did not support better or cheaper care or improved access. Further, the solutions are contrary to the spirit of Medicare and the principles of the Canadian Health Act. Romanow concluded that it would be foolish to jeopardize a world-class health system. Canadians, he concluded, want the health system remodeled, not demolished.
What does it mean to Saskatchewan?
Romanow recommends expanding home care and primary care services, but without targeted funding to train and hire staff, it may not be possible to implement these recommendations.
The nursing shortage in Saskatchewan will likely worsen without specific funding to target the recruitment and retention of nurses. Funding for nursing seats and instructors in Saskatchewan and across Canada should be available so that more nurses can practice, achieving the best patient outcomes.
Saskatchewan residents may not see much change in Home Care services, but if programs are developed to assist informal care providers, some stress may be eliminated.
Not a done deal
The people of Saskatchewan should not assume that because Romanow’s report is in the hands of government, that implementation would immediately follow. The threat of privatization remains. Hidden areas of the health care picture like laundry, cleaning and food preparation services are already subject to privatization. In spite of evidence to the contrary, there are still those Canadians who believe that they should be allowed to jump to the front of the health care queue, based solely on the ability to pay. Canadians told the Commission that they do not want publicly accessed, publicly funded health care to disappear. The people of Saskatchewan are proud to be the first province to enact publicly funded, publicly accesses health care. Medicare is a legacy that Saskatchewan doesn’t want to lose.
Rosalee Longmoore is the President of the Saskatchewan Union of Nurses.
Teresa Neuman is a member of the Board of Directors for Briarpatch Magazine.
Information from: the Romanow Report: Building on Values: The Future of Health Care in Canada, the Canadian Institute for Health Information, the Saskatchewan Union of Nurses, and the Canadian Health Coalition.
Teresa is enrolled in the Bachelor of Professional Arts Program – Communications Studies, at Athabasca University and is enjoying returning to school after 18 years. Teresa enjoys writing, union activism and gardening. Teresa lives and works in Regina, Saskatchewan, with her partner Kevin and son Adam.