Doctors say federal leadership is needed to avert a looming health-care crisis and that better co-ordinated care, not drastic cuts or a move to private care, will ultimately make the public system sustainable.
The Canadian Medical Association said Monday that public health care is in decline. Five million Canadians do not have a family doctor, emergency departments are congested, services for the mentally ill are lacking and many patients cannot afford the drugs they need or a bed in long-term care when it is the best option.
Jeff Turnbull, CMA president, called on the federal Conservative government to create a "Health Care Action Plan" to deal with health issues, much as it created an "Economic Action Plan" to tackle the downturn in the economy. Such a plan, he said, would make the system more effective and accountable.
With the health accord between the provinces and the federal government set to expire in three years, it is time for Ottawa to come off the sidelines and "show leadership once again to tackle the looming crisis in health care," Mr. Turnbull said.
Faced with three years of deficits, Northumberland Hills Hospital, located about 100 kilometres east of Toronto, knew it had to carry out the unkindest of cuts - to some of its health services. But its president and chief executive officer, Robert Biron, wasn't about to do it alone: He asked area residents for help.
This novel approach of creating a Citizens' Advisory Panel on Health Service Prioritization started with a civic lottery of 5,000 citizens in Northumberland County and was narrowed down to 28 people charged with recommending to the hospital board what services it should shed in order to balance its $60-million budget.
The citizens panel spent five full days learning how the health-care system works and, last year, it listed areas of non-core services that could be divested to other agencies, including the hospital's diabetes complication prevention strategy clinic. That recommendation, along with another to get rid of outpatient rehabilitation services, were among those followed by the board. This year, the hospital is expected to have a balanced budget.
"We need a healthy debate about sustainability of the health-care system," Mr. Biron said. "That needs to take place because providers are being asked to do more with less and we believe there are some innovative solutions out there."
But another group of doctors released a report on Monday, timed to coincide with Dr. Turnbull's speech, that argues that public health care is entirely sustainable and that it's the costs of private care that have increased the burden on the system.
Danielle Martin, chair of Canadian Doctors for Medicare, said the notion that the health-care system is about to collapse under its own financial weight is unsubstantiated.
In fact, Dr. Martin said, the cost of basic physician and hospital care has remained stable as a percentage of Canada's gross domestic product for the past 35 years. What has made health care more expensive, she said, is government spending on such things as public health, publicly funded dental care and prescription drugs.
The CMA is succumbing to concerns being expressed by provinces who say health-care spending is eating up a larger part of their budgets, Dr. Martin said.
But "if experience shows us anything, it's that the parts of our health-care system that are paid for publicly are the parts where we have the greatest control over costs," she said.
Both the CMA and Canadian Doctors for Medicare agree that making prescription drugs and long-term care more affordable and accessible would go a long way toward curing what ails the system.
"The concern that we have about the so-called sustainability debate it that it is a real distracter from the conversation that we need to be having, which is about how do we improve quality and get better value for the money that we are spending," Dr. Martin said.
Ontario Health Minister Deb Matthews said the system is sustainable if important changes are made to health-care delivery.
Provinces must rely upon scientific evidence in determining what to fund, must focus on high-quality care, proven to be less expensive than poor-quality care, and the various parts within the system must be better integrated, Ms. Matthews said.
"If we do all that, we will be able to protect our single-payer universal health-care system," she said. "If we don't, we won't."