{"id":3386,"date":"2013-09-15T12:50:26","date_gmt":"2013-09-15T16:50:26","guid":{"rendered":"http:\/\/www.cachc.ca\/?p=3386"},"modified":"2014-01-05T15:04:08","modified_gmt":"2014-01-05T20:04:08","slug":"50-years-of-medicare-in-canada-part-1-a-system-in-need-of-transformation","status":"publish","type":"post","link":"https:\/\/www.cachc.ca\/fr\/50-years-of-medicare-in-canada-part-1-a-system-in-need-of-transformation\/","title":{"rendered":"50 Years of Medicare in Canada, Part 1: A System in Need of Transformation"},"content":{"rendered":"<p style=\"text-align: justify;\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft  wp-image-3387\" style=\"margin-right: 15px;\" alt=\"\" src=\"http:\/\/www.cachc.ca\/wp-content\/uploads\/2013\/09\/Farah-Shroff.jpg\" width=\"101\" height=\"101\" \/><span style=\"color: #000000;\"><em>A Medicare@50 blog post by:<\/em><\/span><br \/>\n<span style=\"color: #000000;\"><em>Farah Shroff, Associate Professor<\/em><\/span><br \/>\n<span style=\"color: #000000;\"><em>UBC School of Population and Public Health<\/em><\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"color: #000000;\">Besides hockey, few things are so quintessentially Canadian as Medicare. Many a Canadian has been known to say, \u201cBeing Canadian is to have universal coverage of medical care.\u201d So it is with great pride that most of us celebrate Medicare\u2019s 50th anniversary this year. I am very excited to be one of the speakers at <a href=\"http:\/\/www.cachc.ca\/?page_id=1896\" target=\"_blank\">Medicare@50: Our Healthy Future and the Roles of Community Health Centres<\/a>, a conference taking place September 25-27 in Saskatchewan, the birthplace of Medicare.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"color: #000000;\">It was a long and arduous effort to bring essential medical care to all Canadians in 1963. Prior to the implementation of Medicare, those without ability to pay suffered from easily treatable conditions. Some died for lack of life-saving care. While some features such as geography still hamper ease of access to care, financial barriers have largely been removed from the equation.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"color: #000000;\">Social justice issues are paramount in the discussion of universally accessible medical care. Canadians of all religions, ethno-cultural groups, genders,\u00a0ages, illness statuses, and so forth are eligible to receive care. The Canada Health Act enshrined this in legislation, guaranteeing five principles:<\/span><\/p>\n<ul>\n<li><span style=\"color: #000000;\">Accessibility: all insured people are assured reasonable access to medical services.<\/span><\/li>\n<li><span style=\"color: #000000;\">Universality: all insured Canadians are assured the same level of medical care.<\/span><\/li>\n<li><span style=\"color: #000000;\">Public accountability: administration of health care is carried out on a non-profit basis by a public body.<\/span><\/li>\n<li><span style=\"color: #000000;\">Portability: Canadians may move from one part of the country to the other and receive the same standard of medical care.<\/span><\/li>\n<li><span style=\"color: #000000;\">Comprehensiveness: all medically necessary services are insured.<\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify;\"><span style=\"color: #000000;\">While there have been challenges, Medicare remains intact today. Unfortunately we are paying approximately $200 billion a year for this program, and costs continue to spiral. If we are unable to curb these burgeoning costs, we are going to lose Medicare.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"color: #000000;\">The system requires innovation and transformation. Working as a consultant for the Institute for Health\u00a0<\/span><span style=\"color: #000000;\">System Transformation &amp; Sustainability, I wrote a paper for British Columbia\u2019s health care leaders \u2014 \u201cInnovation and Transformation in Health Systems: A Primer for the BC Health Authorities\u2019 Leadership Council\u201d \u2014 that states:<\/span><\/p>\n<blockquote>\n<p style=\"text-align: justify;\"><span style=\"color: #000000;\">\u201cTransformation is a change in form, appearance, nature, or character. It is a foundational alteration in the way in which health systems are conceptualized, designed and do business. Innovation is a catalyst for transformation. Literature on the implementation of large\u2010scale system change offers a few theoretical and practical guides for such overhaul; the Consolidated\u00a0<\/span><span style=\"color: #000000;\">Framework for Implementation Research (CFIR) and the Tyler Collaboration model are a couple of these which have been tested in the health sector.\u201d<\/span><\/p>\n<\/blockquote>\n<h3 style=\"text-align: justify;\"><strong><span style=\"color: #000000;\">The need to redesign the health system<\/span><\/strong><\/h3>\n<p style=\"text-align: justify;\"><span style=\"color: #000000;\">The Canadian health system is unsustainable financially and otherwise; costs continue to increase, and continuing \u201cbusiness as usual\u201d will not meet growing demand. Canadian governments currently spend $200 billion a year nationally; most provincial governments spend half of their budgets on health systems. Health system costs outdistance the growth of Canada\u2019s GDP, while demand continues to grow, partly due to increased rates of chronic conditions. Most of our system is based on short\u2010term, acute, episodic care\u2014not adapted to the current reality of long-term health problems that require more education, promotion, and disease prevention. Self\u2010management, peer\u2010to\u2010peer support, and group\u2010based courses on chronic conditions, proven to improve outcomes and save costs, are a small feature of the health services landscape.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"color: #000000;\">On the whole, patients report satisfaction with hospital care, and it seems to function relatively well for acute problems. On the other hand, patient safety is a serious concern, specifically in our hospitals. Costs continue to spiral, partially as the price of patented pharmaceuticals take a greater share of the pie; physician and surgeon services are the greatest single cost to the system. Primary care is in crisis; while Community Health Centres, nurse practitioners, and other viable solutions exist, political quagmires have prevented them from proliferating.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"color: #000000;\">Canada ranks near the bottom of OECD (Organization of Economic Cooperation and Development) nations in terms of quality of our health system and its outcomes. Finally, reducing and eliminating social and economic inequities will make a significant impact on health outcomes. Redesigning health care systems\u2014the focus here\u2014would also improve health outcomes.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"color: #000000;\">Transformations should produce better health and better care at better value, so they improve health status, improve quality and decrease cost. They ought to create evidence\u2010based, patient-centred collaborative, integrated care systems.<\/span><\/p>\n<p style=\"text-align: justify;\"><i>Farah Shroff, Ph.D., is Director of the Adler School\u2019s\u00a0M.A. in Community Psychology\u00a0program at its Vancouver Campus.\u00a0 Dr. Shroff, who also works in the Department of Family Practice and the School of Population and Public Health with the University of British Columbia Faculty of Medicine, emphasizes visioning and developing\u00a0<\/i>Health for All.<i>\u00a0<\/i><i>A researcher, educator, and community organizer, she focuses on the areas of holistic health and spirituality, community development, and social justice, as well as health services policy research. As a consultant, Dr. Shroff has served many public and private clients; she has also worked for governments in Canada and non-governmental organizations such as the Downtown Eastside Residents\u2019 Association in Vancouver.<\/i><\/p>\n","protected":false},"excerpt":{"rendered":"<p>A Medicare@50 blog post by: Farah Shroff, Associate Professor UBC School of Population and Public Health Besides hockey, few things are so quintessentially Canadian as Medicare. Many a Canadian has been known to say, \u201cBeing Canadian is to have universal coverage of medical care.\u201d So it is with great pride that most of us celebrate Medicare\u2019s 50th anniversary this year. [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_topic_count_hidden":0,"_bbp_reply_count_hidden":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[42,40],"tags":[],"class_list":["post-3386","post","type-post","status-publish","format-standard","hentry","category-medicare-50","category-strengthening-medicare"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.2 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>50 Years of Medicare in Canada, Part 1: A System in Need of Transformation - ACCSC<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.cachc.ca\/50-years-of-medicare-in-canada-part-1-a-system-in-need-of-transformation\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"50 Years of Medicare in Canada, Part 1: A System in Need of Transformation - ACCSC\" \/>\n<meta property=\"og:description\" content=\"A Medicare@50 blog post by: Farah Shroff, Associate Professor UBC School of Population and Public Health Besides hockey, few things are so quintessentially Canadian as Medicare. 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