Waiting for Health Care in Canada
Yesterday morning I was reviewing the situation of one of my young patients whose usual medication had, within the last two weeks, gone into short supply. Over the last year this has become a very common occurrence in Canada as both family physicians and specialists struggle to find acceptable medications for patients when the pharmacy reports that that a usual medication is not available.
What struck me on this particular day was not the reason for the shortages, or how the federal government could assist in dealing with this difficulty but rather the willingness of Canadians to accept that this was the case and of their doctors not to insist that the situation must be addressed by whichever government might be able to broker a deal between Canada’s Research-Based Pharmaceutical Companies (Rx&D) and the Canadian Generic Pharmaceutical Association (CGPA).
This characteristic is, in fact, very typical in the history of Canadian medicare, it seems to me. What did Canadians and their doctors do when governments cut medical school funding and no one could find a family doctor? They found ways to manage, whether through walk-in clinics for patients, or by family doctors stretching their work day. Together, Patients and Doctors were not able to convince governments that this was premature, or that the evidence about physician surpluses might not consider all the data, or the reality that aging Canadians were going to require more care was information that could throw off all 1982 predictions for how large a workforce was needed.
In the past twenty years, wait times for diagnostic tests, procedures and access to consultation have increased to a point where outcomes are compromised and the stress of having a chronic illness is exacerbated. In 2004, the Wait Time Alliance was created to monitor the benchmarks for wait times established in the 2004 First Ministers’ 10 Year Plan to Strengthen Health Care. The Alliance consists of various physicians groups, including the Canadian Medical Association, concerned about wait times for patients and determined to work with stakeholders to improve access to care. While the Alliance continues to report annually on progress, this year’s report comments, “Although some provinces have shown improvement, the overall results point toward lengthier waits for Canadians”.
And so we wait, and manage, even as there is evidence that the system is no longer sustainable. Financial pressures in Ontario have given rise to labour disputes with doctors. The numbers of patients waiting for long term care beds continues to rise, leaving them in inhospitable hospital wards and leaving other patients receiving ward care in Emergency Rooms until they can have access to expert medical, surgical or psychiatric wards.
Why don’t we get fed up? Why don’t we write to our legislators? Why not let the Health Minister and Prime Minister know that throwing money at the problem is not enough anymore? That they must actually begin to consider what investment is needed to sustain a system that really doesn’t cover the basics at all?