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Governments keep telling Canadians how they are going to "fix" the health-care system. Yet many problems are actually getting worse, including longer wait-lists for diagnosis and surgery, over-crowded emergency rooms, and increasing shortages of family doctors.
While in general we are living longer, there are worrying developments. Particularly disturbing is the numbers of illnesses and syndromes that afflict our children. If we were an animal species, looking at issues of population health, we would notice and worry that our young do not have -- on a population basis -- the state of health of earlier generations. Some have noted that the trend toward every generation being healthier than their parents is about to abruptly end. Industrialized countries have seen a rise in children's cancer. One in five Canadian children has asthma. There is an epidemic of obesity in children. Rates of diabetes in our children have also gone up. And the rate of attention deficit disorder, autism, and mental retardation are on the rise.
Meanwhile, we are told the cost of health care will be driven up by the aging population. It turns out, that claim lacks empirical support. According to the Canadian Institute of Health Information:
"Analyses of the drivers of increases in public sector health expenditures over the last decade showed that the contribution of aging has been relatively modest. To date, system-level cost drivers such as inflation and increased utilization have played bigger roles in health spending increases.," (Health Care Cost Drivers: the facts, CIHI, November 2011)
So what is driving up the costs of our health-care system?
Skyrocketing costs for pharmaceutical drugs have now eclipsed all other health-care expenditures. Drugs are the fastest rising component in health-care costs. Pharmaceutical companies claim that the high prices -- many times more than the actual cost of manufacturing the drug -- are necessary to recover their investment in research and development. Recent studies from around the world have debunked this claim. (Light, et al, "Will lower drug prices jeopardize drug research: a policy fact sheet," American Journal of Bioethics, 2004.)
The high mark-up on prescription drugs simply cannot be justified based on the investment in research. We are being ripped off by Big Pharma. But we may also be suffering more harm than benefit. The world-renowned Therapeutics Initiative at University of British Columbia operates as the Gold Standard of pharmaceutical reviews. It spotted problems with Vioxx, even as Health Canada approved the drug.
Its review of the data package from the manufacturers has saved B.C. lives and tens of thousands of dollars. One aspect of Therapeutics Initiative that makes it nearly unique is that it refuses any perks from the pharmaceutical industry. As I learned when visiting their centre at UBC, for every doctor in Canada, there are three drug salesmen, and there are many offers of conferences in exotic locations to better acquaint doctors with the prescription drugs on offer.
Meanwhile, the traditional way that governments deal with health-care, throwing more money to the provinces, is not achieving concrete results. The 2004 First Ministers Health Accord committed $41-billion to health-care system improvements, including $5.5-billion over 10 years to reduce wait times. Benchmarks were established in December 2005 in five key health-care areas that have been prone to longer waiting times. So far, progress is mixed, even though reducing wait times was one of only five promises made by Stephen Harper in the 2006 campaign. That Health Accord is due to expire in 2014.
To get a handle on rising health-care costs, we should focus on drug costs, but we shouldn't stop there. Here is a short list of where we should look.
- Improving the bed to bureaucrat ratio (more beds; fewer bureaucrats). Special effort should be made to expand availability of lower cost long-term care and recuperation beds, leaving high-cost post-op beds available for people who really need them.
- Creating a national pharmacare program with bulk buying of drugs at the federal level to provide at lower cost to provinces. Support the University of British Columbia Therapeutics Initiative and expand its approach to ensuring drugs are only registered if they do more good than harm, across Canada.
- Focus on efficient use of resources. Not every patient needs every diagnostic test. This bioethics discussion has been growing in the medical literature. Avoiding waste is a sensible approach, but can be difficult to implement, ("From an Ethics of Rationing to an Ethics of Waste Avoidance," New England Journal of Medicine, May 24, 2012).
- Provide student loan forgiveness incentives for graduating doctors, nurses, paramedics and other health-care professionals who agree to staff rural facilities and family practice clinics where recruitment is currently a problem.
- Enshrine a policy that seniors' care must be provided in the communities where they or their families live.
- Expand home support and home care programs and assisted-living services to support people with chronic care needs, including many seniors who wish to stay in their own homes and communities.
- Ensure that the Canada Health Act is enforced. (i.e., the federal government cannot wash its hands of health care.)
- Follow through on our commitment to a national Mental Health Strategy.
- Expand our awareness and investment in prevention. Focus on nutrition. Restrict more carcinogenic, neurotoxic, and immune-suppressive substances. Ensure physical activity from pre-school through high school.
Green Party Leader Elizabeth May represents Saanich-Gulf Islands, B.C. This article was first published in The Hill Times.