It looks like much of the next decade or so will be taken up with managing record levels of government and household debt and spending. With an aging population requiring health care how are we going to continue to pay for necessary health services that we want and need? Thankfully, advances in telecommunications and computer technologies provide us with opportunities to rethink much of what and how health and social services can be provided.
A useful perspective is provided in the Health Council of Canada report entitled Seniors in need. Caregivers in distress: What are the home care priorities for seniors in Canada. The Health Council report examines the challenges of integrating home care with hospitals and primary care emphasizing the need to enable both ‘horizontal and vertical integration of health and social services for the elderly. The report suggests increasing the role of case management for groups who consume a disproportionate amount of health care resources, such as the elderly or people with poorly managed chronic health problems, such as diabetes, heart disease or cancer. Case managers support access to preventive care in the community for people at risk of developing chronic diseases and curb our dependence on more costly acute hospital services or walk-in clinics. Such an undertaking requires a comprehensive review and rewriting of the existing policies, regulations and funding models that support the current jumble of acute care, primary and community care services.
Unfortunately, health care funding incentives are notoriously fractured – often pitting groups against each other … particularly in constrained times. Will hospitals, boards, executives, physicians, labour unions, government bureaucrats, politicians, … and the public chose to work together to ensure both horizontal and vertical alignment of health care resources (people, equipment, facilities, supplies, budgets, and contracts) so that essential health and social services are better coordinated for patients long into the future?
If so, what changes must we collectively and individually make to the many interlocking policies, regulations, bylaws, contracts, licenses and agreements … for improved patient care? When reallocating resources what is the relative value of competing areas and how do we determine value for money? Importantly, how do the government and key health care stakeholders retain constructive working relationships that are necessary for working through the difficult tradeoffs required?
Health care is first and foremost about serving the health needs of patients. Fortunately we have highly trained health professionals who are for the most part motivated by a desire to provide compassionate high quality care. The public supports investing large amounts of public funds (almost 50% of the Provincial Budget) and resources into health and other social services – as long as these investments serve their health care needs. Perhaps the silver lining of this era of cut backs and deficits is the impetus it provides for working together to get back to the basics of health care.
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