Pay attention, because medicare is about to change

By Jo-Ann Fellows
Daily Gleaner
October 18th, 2011

In 2014, the current agreement on medicare between the federal government and the provinces will expire, and a new agreement will be required.

Significant amounts of money will be involved, and the shape of our health-care system for the next few years will be determined.

There is general agreement in Canada about what the new health-care system should contain. The problem will be in "transforming" our current system to get to the new one.

The new system must accommodate the advances continuously being made in medical science. We must move from a "sickness" system, where diseased and injured patients are treated, to a system where keeping people healthy predominates.

We must move from a hospital-based, acute-care system, with primary care being delivered in family doctors' offices, to a narrowing of the scope of hospitals and a considerable enlargement of primary care being delivered in the community.

This care will be delivered by various agencies, including community care centres, augmented doctors' offices and clinics. As well as making referrals, these organizations will assist the patient in the management of chronic disease, and contribute to encouraging good health.

There will be tremendous resistance in making these changes. Hospitals will resist, as well as some physicians. There are many with a vested interest in the current system.

Making these changes will take courageous leadership. It would be impossible to over-emphasize the political and administrative skills that will be required. We need people to think about the provision of good care first, and their own interests second. The public will have to be alert so that they can assist in this transformation.

The amount of money presently being spent, with an adjustment for inflation, is sufficient to pay for the new system. If you are going to add services, then cuts will be required in the old system. The transformation should be revenue neutral. At the moment, the cost of Canada's health-care system as a percent of GDP is higher than that of a number of European countries, and their systems are better than ours.

As part of the up-grading of our system, we need a national prescription drug insurance plan, and we should add a dental plan. We need to revolutionize the way we deliver long-term care, and to strengthen home care. A better source of rehabilitation between the hospital and the home is also required. There has always been a gap in our system for this service.

Remember that these improvements must be made with current funding provided by both the federal and provincial governments. The new funding from the federal partners is already promised to be increased by six per cent annually, as a result of a promise made by the Conservatives during the recent election campaign.

We need a revitalized system. The status quo is not acceptable. Too much funding is going to the wrong things. There is no other way to achieve an accessible, fair, equitable and high quality health-care system. Canadians place great value on their health-care system. The public will have to exert pressure on all the governments to facilitate this decision-making process.

Once agreement is reached, it will take a highly skilled and dedicated group of administrators to drive these changes, with support from all the players in the health-care system.

Basically, we need to decide on the shape of medicare for the next few years. The federal government has been waiting for the provincial elections to be completed, in order to determine the players in this negotiation.

The public should pay close attention to these discussions.

Jo-Ann Fellows is a writer with an interest in health care. She lives in Fredericton.