Unit 9 Flashcards
describe the issues concerning the fiscal sustainability of health care systems in Canada.
The Romanow Commission on the Future of Health Care in Canada was introduced in Unit 6.
This Commission described “sustainability” as the sufficiency of resources “over the long term to provide timely access to quality services that address Canadians’ evolving health needs”
These resources are not just financial, but include human and physical resources, e.g., physicians, dentists and nurses who provide care, as well as hospital and clinical facilities, information technologies and medical technologies such as X-ray equipment and radiotherapy facilities
Fundamentally, however, since financial resources are required to pay for human and physical resources, fiscal sustainability depends on two factors: the revenues generated by governments through taxation and other means, and the expenditures on health services that governments decide to provide
Since governments have to provide a variety of public services (education, highways and roads, etc.), in addition to health care, fiscal sustainability also depends on the portion of revenues a government chooses to specifically spend on health services.
identify the drivers of costs in health care.
Among the key “cost drivers” identified to the Romanow Commission (see Unit 6) are prescription drugs, health technology, the aging population and genetic testing.
The effects of prescription drugs on health expenditures in Canada have been well documented. Until about the middle of the 1980s, prescription drugs took up about 6% of expenditures, and now (as reported previously) they exceed 17%.
Other health technologies are also costing the health system more. New and more innovative, non-invasive surgical techniques are being developed in academic medical centres, quite often with major cost implications. Increasing use of such techniques, e.g., using lasers and endoscopic techniques which reduce the need for surgery, is expected because of patient preferences for non-invasive methods of treatment.
The aging of Canada’s population will also affect the need for health services. In the year 2000, approximately 12% of the population was over 65 years of age. It is projected that by 2030, this will grow to over 22%. It is well known that older populations require more health services than younger ones.
Genetic testing is expected to have a significant influence on health care in the decades to come. In part, this is due to the anticipation that physicians, researchers, patients and investors have that new genetic tests will be developed in the next decade or two for predicting common illnesses, such as diabetes and heart disease.
explain some of the issues concerning health workforce issues in Canada.
Recently, it has been stated that because of the “graying” of the population, there will soon be even fewer physicians, nurses and health system leaders. Recruitment and retention of health professionals appears to be a challenge across all provinces, especially in rural regions.
However, there are ethical issues surrounding the active recruitment of foreign physicians (as well as other health professionals, such as nurses). Physician have the right to practise when and where they choose. Yet, citizens paying taxes that subsidize the medical training of physicians also have the right to seek treatment from the same physicians they subsidize and, so, the dilemma arises when many foreign trained doctors seek employment in Canada.
The situation with registered nurses is very similar. There are dire predictions, particularly from the nursing profession, that the existing shortage will grow in coming years;
The situation with physicians and registered nurses will likely remain, if not deteriorate, especially because many of these professionals will be facing retirement in the near term.
identify future policy questions regarding medical technologies.
At the federal level, regulatory policies will have to adjust to new entities such as stem cell therapies that will soon reach the market. Existing regulatory processes of review and decision making may not be adequate in dealing with such technological innovations, because some of these innovations may be targeted toward individuals (e.g., according to genetic make-up).
New policies must also bear in mind that there is a global market for such technologies, that manufacturers are in a global arena, and that there are international treaties in place that must be respected.
Thus, although the federal government develops policies with respect to what can be sold or marketed in Canada, the provinces and territories develop policies that deal with payment or coverage of what is sold or marketed. Given the financial constraints faced by governments, and the ever increasing demand for new technologies, difficult choices have to be made.
explain how policy makers have dealt with pandemics in Canada and what this means for the future.
Health policy and decision makers had to deal with the SARS epidemic by instituting new policies and procedures. These included increased vigilance at airports, SARS control directives for hospitals, quarantine of individuals and, in Ontario, closure of one hospital to all but SARS patients.
The federal government had to commit to paying for part of the health care tab, and the federal government also had to pay for the cost of encouraging travel to Canada, because tourism had dropped significantly as a result of the epidemic.
“Public health” became a high priority in Canada. In part as a result of SARS, the government created a new federal body, the Public Health Agency of Canada (PHAC). Numerous policy interventions across government sectors had to be implemented to deal with the SARS pandemic; thus, the epidemic identified a new area in which health policy makers will need to focus efforts in the coming decades
The Public Health Agency of Canada Act, which established PHAC, states that “’Public health’ is population-focused and includes disease surveillance, disease and injury prevention, health protection, health emergency preparedness and response, health promotion, and relevant research undertakings”
In order to achieve public health goals, other areas, such as social services, transportation, municipal planning, physical fitness and exercise, health living, emergency services, etc. will need to be engaged. Health policy makers of the future will need to approach policy problems in a broader way, and be able to communicate with policy makers from other sectors—sectors that might traditionally have been seen as competitors for public funds.
In the public health world of the future, health and social services will have to tackle policy challenges together, and competition for resources will have to be approached differently.
