Quality health care is attainable and sustainable in Canada, says analyst

December 2010- Contrary to popular belief, Canada's aging baby boomers are not threatening to bankrupt the health care system. The real culprits are inefficiency and wasteful spending, says Michael M. Rachlis, MD, a health policy analyst and coauthor of a new report called The Sustainability of Medicare.

“We can afford quality health care. We can't afford poor quality health care,” said Dr. Rachlis, speaking at the 30th annual meeting of Concerned Friends.

Health expenditures have grown as a share of provincial government spending but this is mainly because other areas such as social services have been cut. There has not been much change in public health care's share of our overall economy.  Tax cuts also distort the picture. Indeed, tax cuts have reduced our ability to pay for the health care we need, the report states.

The good news is that today's baby boomers are in far better health than their parents were. A U.S. study published this year in Science reported that while life expectancy is rising, the number of disabled people over the age of 65 is not rising nearly as fast. This also appears to be true here: the aging of the population has only increased health care costs by an average of 0.8% per year since 2001, and this is expected to rise to 1% per year during the next 25 years, Dr. Rachlis said.

What to do?

The Ontario Health Quality Council (OHQC), which was mandated in 2006 to measure and report on the quality of home care services in Ontario, has come up with a picture of what a high-performing health system should look like. Its 2010 annual report identified roadblocks in patient flow that are creating a log jam in emergency care, for example. Patients admitted to hospital from the emergency department typically spend more than three hours waiting for a hospital bed after the decision to admit.

Under these circumstances, it is perhaps no surprise that elderly patients transferred to emergency rooms are often considered to be a nuisance. However, the frail elderly are the very people that emergency departments should be there to serve, Dr. Rachlis noted.

The OHQC has also reported that long-term care wait times have tripled since 2005, and are now at 105 days – but one in four people placed in long-term care could potentially be cared for in alternative settings. This is having an impact on the hospital sector, where 16 percent of hospital beds are being designated as ‘alternate level of care.' This problem has grown worse over the past three years.

Overall, the most immediate problem appears to lie in Ontario 's inability to provide good primary level care, according to Dr. Rachlis. Approximately seven per cent of adults in Ontario continue not to have a family doctor – that's roughly 730,000 people, according to the OHQC.  Nine out of 10 who do have doctors say say they have to wait too long to see them.

“Trying to deliver health care services without adequate primary health care is like pulling your goalie in the first period,” he said. "To remedy this, we need public forums to debate the future of Ontario 's primary health care reforms."

The old saying, “an ounce of prevention is worth a pound of cure” has never been more apt.

For more information visit: www.michaelrachlis.com and www.ohqc.ca

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