A generation ago, universal single-payer health care was on the cutting edge of policy. Today, it has become clear that this way lies disaster, and significant changes are needed if Canada’s health system is to keep functioning. It’s fitting, then, that Claude Castonguay, a former Quebec health minister known as a “father of medicare,” is leading the charge toward health policy reform today.
The Castonguay report, released last week, does a remarkably good job of identifying the best practices of foreign health care systems that might be brought to Quebec, and by extension to the rest of the provincial medicare systems.
He recommends a hike in sales tax to fund health care, which is a dead end in health policy debates, since Canada already outspends most of the world, and resource reform is not the key issue here. That aside, the policy recommendations are spot-on, and include some of the best aspects of health care in other jurisdictions.
On the subject of funding, the report notes with concern the growing gap between the economic growth and rising health spending. We can’t go on effectively paying ourselves more than we earn, and the health sector consumes an ever greater share of our GDP. An expanding economy can defer the point at which our health care system is bankrupt, but to avert this situation entirely requires something more, and the report’s recommendation to tie increases in health spending to economic growth is an excellent first step.
Another crucial component of the report is the emphasis placed on the citizen within the health care system. The health care consumer, the report states, “must also contribute to the system’s funding according to his means, and in accordance with his consumption of care.” While this sounds revolutionary to some Canadians, trained to perceive health care as free because they pay nothing for it at the point of consumption, it is in fact consistent both with the best performing health care systems elsewhere, and with the principle of individual responsibility.
With respect to improving health care access, outcomes and costs, the Castonguay report comes down strongly in favour of a very powerful tool for reform: getting government out of the business of providing health care.
There is ample work to be done in regulating health care, setting health policy and standards, and allocating budgets for capital investments and ongoing costs, and provincial governments are in an excellent position to provide that oversight. If Canadian health ministries restricted themselves to these functions, and permitted health care providers to concern themselves with the production of health care, we would bring our system into line with the most successful European health care regimes.
The report also stresses the centrality of prevention and health maintenance. Connecting in the minds of consumers the relationship between their overall health and their demands on the health care system is certainly one aspect of this. Taking concrete steps to maintain health, rather than waiting until illness develops and then treating disease, is a key to lowering health care costs and improving outcomes.
The goals Castonguay sets of access to a personal primary care physician or clinic for each Quebecer, as well as universal electronic patient records, are the foundation of preventive medicine. Having all one’s medical records in the hands of one physician, and in an easily accessible electronic format, enables the detection of problems before they become serious.
Also encouraging is the discussion of effective use of pharmaceuticals, and of home care for the elderly. The massive demographic shift on the horizon, in which an elderly population will live longer and be supported by a lower ratio of workers than ever before, means that any plan to make health care accessible and affordable must address the medical needs of an aging population.
It has been proven that optimal use of drugs, especially for chronic conditions such as hypertension and diabetes, can drastically lower both the incidence of further illness and the overall costs of treatment.
For seniors suffering from a loss of autonomy and mobility, home care is both sought after by the patients themselves and less expensive than institutional care.
The Chaoulli judgment opened the door for meaningful health care reform in Quebec. This paper defines some concrete steps the Quebec government can take to rise to the challenge. All Canadians interested in the future of our health care system should watch carefully to see what components are implemented, and how they fare.
The Castonguay report liberates the debate from the orthodoxy of the Canada Health Act and suggests evidence-based changes that have been proven elsewhere. If health ministers elsewhere pay attention, Claude Castonguay may be remembered not only as a father of medicare but also as one of its rescuers.
