Massive Changes Needed
Timid politicians block meaningful changes in the delivery of Health Care. The major preoccupation for all politicians is to get elected and then re-elected. Everything politicians do is measured in terms of how it affects their chances in the coming elections.
Governments, both provincial and federal are involved in many issues, such as soft-wood lumber, child care, different taxes, tenant landlord relations etc. All these issues are not vital for the great majority of people most of the time. Health Care is different. Sterling Lyon, a former premier of Manitoba, 1977-1981, raised the fee for the Manitoba Health Plan, and was soundly defeated in the next election after only one term. A lesson not lost on the other premiers in Canada.
Health care affects a lot of people all the time and can in an emergency affect anyone. It is an issue that is usually handled with extreme care and that in itself is a major problem. “Better to do nothing than to correct a situation in health care and create turmoil”. We cannot ignore this issue in the future. Drug costs have risen 140% since 1977 and the government spends $3.4 billion on the drug benefit program. With the costs for medical and hospital care rising constantly and with the new technologies available, a way must be found to change the system so as to incorporate these new technologies but to deliver the standard care at a lower price.
The entry to the health care system is the family doctor who does a myriad of tasks, some requiring a lot of expertise but others can be done by specially trained pharmacists and nurse-practitioners. These people would be allowed to diagnose and prescribe, under strict controls, for specific illnesses. Even with some of the specialists there are areas in which the job can be done by these professions. It goes without saying that these tasks would be performed for a lesser fee than presently paid to physicians. Planning and implementation could be fine-tuned in northern Canada where doctors are not found in great numbers.
Some doctors now routinely demand a visit to repeat a prescription. Pharmacists could be assigned this job, under certain guidelines, saving many office visits.
The research-based drug companies are constantly bringing out new chemical entities at high prices. The problem is that some of these products are not much different than drugs presently in use at generic prices. It is estimated that only one in twenty new drugs put on the market are significant break-through. When a new drug comes out, the pharmacist could advise the doctor what the criterion could be, to abandon the old therapy, and get on with the new. The money saved could be very significant.
You can rest assured that the medical profession and the research-based drug industry would be very unhappy with health care going in this direction. The doctors keep asking for more money, with no other solution in mind to solve their problems, and the research-based drug companies want a free hand to continue on as they have in the past. Changes must be made in the delivery of health care. What is proposed in this article is now a fact, more or less in some U.S. states, in England and even in some provinces.
The pharmacist and nurse practitioners involved in this change (not necessarily all in the profession) would need extra training in diagnosis and prescribing. A myth propagated by the Medical Profession is that they are the only people capable of doing these tasks. That is not so, and in fact many mistakes are made. It is believed that over 20,000 Canadians die annually of medical errors and about half of these deaths are due to the overuse or misuse of prescription drugs. Pharmacists today,under present rules, routinely prescribe medicines kept only in the dispensary and are very skilled in picking up mistakes in over-doses and drugs that should not be prescribed together.
A way has to be found to make the changes in a manner causing the least turmoil for the professions involved, but turmoil there will be, and the question is. Can the politicians take the heat?
