standing committee presentation
A presentation to the standing committee on social policy to consider Bill 97, an act to increase access to qualified health professionals for all Ontarians by amending the Regulated Health Professions Act, 1991.
Personal modesty is not called for when one tries to promote a change that will literally revamp a portion of our health care system. My name is Murray Rubin and I graduated in pharmacy at University of Toronto, Faculty of Pharmacy, in 1954. I operated a mail-order pharmacy named Vanguard Drug Mart in 1960, in Toronto, from a second floor location, in order to be able to lower prices to my customers by lowering my overhead. I was very successful. When I sold my stores we had over thirty traditional pharmacies in operation throughout the province. I have no financial interest in the health care system today.
We were the first retail pharmacy to computerize our prescription records. All pharmacies are now computerized. We were the only pharmacy to regularly phone doctors, all over the province (at our expense), to ask to change brand-name drugs to generics in order to save our customers money. Years later the Ontario government passed a law allowing all pharmacists to do what we regularly did, but without the need to phone doctors for permission.
The players and their prejudices in the health care system
The Players in the health care system are the politicians, the public, the health care professions and the companies that provide the ancillary services that allow the system to operate. The companies are beyond the scope of this presentation.
The politicians
Most politicians are interested first and foremost in getting reelected. They start every project with the best of intentions but after they have consulted all the players and have seen that changes will cause a lot of dissension, will take time, and they will probably not be in office when the system works well, they back off and do as little as they can get away with. 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. Bill #97 is as little as they can get away with.
The public
The public wants the best health care, wants it free and wants to pay as little in taxes as possible.
The health care professions
The primary interests of the professions are to provide good health care, to protect the privileges accorded them by law (protect their turf) and to make sure the fees they receive from the government are not lowered.
The changes we need, as soon as possible
There are many changes necessary in our health care system, but because of time limitations, I intend to discuss the areas around the general practitioner (G.P.), nurse practitioner, and the pharmacist.
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 $5016.00 and those aged 80-84 was approximately $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.
We do not need more G.P.’s except possibly in remote areas. We need pharmacists and nurses to do some of the less complicated work done by G.P.’s for less money. We need to save money!! Nurse practitioner clinics such as the ones in operation in Sudbury is one answer. They work on salary. Pharmacists in drug stores can give advice for a fee, on minor colds, head-aches, etc. and if necessary send the patient on to a doctor. Pharmacists should be allowed to repeat a doctor’s prescription and save a fee for an office visit. When I spoke to my G.P. about the need for more doctors he laughed and said if some G.P.’s did less botox work they would have more time for regular work. The pharmacist should be allowed to advise the doctor that the new prescription he has just prescribed is not necessary as the drug in use now is fine a 1/10th the price. A myth propagated by the medical profession is that they are the only people capable of doing these tasks. That is not so. Many mistakes are made by doctors. Will the government easily make these changes? You bet your life they will not!
What should be done by government
Appoint committees of people to go over what each profession does. Include members of each profession on these committees. Look for ways to give similar service for less money. Professions are not entitled to stay static forever. Conditions change. We have to teach less qualified people to do the less complicated work. Take it out of the hands of the government and then perhaps progress can be made.
