Changes in Health Care
It is not readily apparent to the general public but, in theory, the provincial and federal governments could change the way the health-care professionals practice. In the real political world when it comes to health care, the politicians tread very carefully and go out of their way to avoid disturbing the system in place. In a recent meeting of the general council of the Canadian Medical Association in Vancouver, motions were passed condemning any proposals allowing other then physicians the right, by law, to prescribe. Pharmacy and Nursing associations called the doctors “paternalistic, pathetic, paranoid and desperate to protect their turf.
The systems in place to-day may have to change dramatically. We are headed into a demographic disaster. It is a well-known fact that our older population uses up a disproportionate amount of the health-care dollar. Average spending in Canada per person per year on health care in 2004 was $2630.00, while spending for those aged 65-69 was $5,016.00 and those between 80-84 was around $11,902.00. The total population grew by 5.4% over the past 5 years while the 55-64 group increased by 25%. One in every seven Canadians is a senior citizen according to the 2006 census. Life expectancy is up while the fertility rate of women is down below the replacement level to maintain our population. In essence there will be fewer younger people working to pay the taxes to maintain the health care of the elderly.
In April of 2006 the McGuinty Liberal government, in a press release, announced a comprehensive plan to reform Ontario’s drug system, health and long-term care. To quote the minister George Smitherman, “This package is about improving patient access to drugs, and to do so more quickly and more transparently. We also need to get better value for our money in order to make our drug system – and our entire health care system – more effective and sustainable. Better drug pricing would mean we can reinvest savings in the drug system and make sure consumers get the innovative drugs they need.”
The minister has brought a measure of reform to, relatively speaking, “minor problems”. Quicker access to break-through drugs, reducing paperwork for doctors, paying the pharmacist to provide enhanced patient counseling, and monitoring rebates to pharmacists from generic drug companies. The minister is treating a cancer patient (the Ontario health-care system) with solutions for a common cold.
The entire health-care system has to be examined with two aims in mind. Offer excellent health care as it is provided now, using different professionals at a much lower cost.
Let’s start with the research-based drug companies. They spend tens of millions on research and similar amounts on promotion and usually bring out a new drug at an inflated price that is only marginally, if at all, better than the drugs used today. It is estimated that one in twenty-one drugs released for use are of major importance. These companies have a right to produce these “me-too” drugs but the government can appoint the pharmacist to check these new drugs against what is in use today for a particular patient to see if the higher price reflects in a healthier patient. A recent headline in the New York Times read “Psychiatrists top list in drug-maker gifts”. All gifts to doctors must be called “unethical” for they are primarily used to induce the doctor to write the newer and more expensive pharmaceuticals.
Fewer doctors should become general practitioners (GP’s) and allow pharmacists and nurse-practitioners to handle the “minor” problems faced by GP’s. In Northern Canada where doctors are scarce, nurse-practitioners do the job of the GP’s very successfully. The solution will be arrived at by the government and the professions over a period of time.
All the work done by doctors, dentists, pharmacists, nurses and optometrists must be examined to see if their jobs can be inter-changed at a lower cost. As an example, to its credit, the Ontario government will soon license dental hygienists to practice independent of dentists. This could change the way basic preventative oral care is offered in Ontario, surely at a lower cost. Pharmacy technicians are being given legal status to allow the pharmacist the freedom to broaden his practice and be available for more important work. Optometrists should be required by law to do all refractory work, allowing ophthalmologists the time for eye operations and more complicated procedures.
A recent development on June 17,2016 by the federal government allows MAiD, or medical assistance in dying. Pharmacists and pharmacy technicians are exempted from criminal liability when dispensing a prescription written by a doctor or nurse practitioner for this purpose.
It is imperative to make it very clear to those in practice today that the transition will be slow and careful and those in practice today have nothing to fear from the changes.
