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Yvonne Berg

Why are Canadians overusing emergency rooms in hospitals when compared with patients in 10 other countries tracked in an international study? Because in Canada the emergency room is the only port in a storm. The answer is to create more ports - but not to spend more money doing so.

People have the disconcerting habit of getting ill or having fairly minor accidents (major ones, too) after doctors have gone home for the day.

Innovation is key. There is surely an opportunity here for entrepreneurs. Urban walk-in clinics that are open weekends and after-hours seem a good bet to make money. (Profit does not need to be a dirty word in medicare.) Hospitals or public health centres can offer a hybrid service, halfway between emergency and ordinary care in off-hours. Alberta Health offers just such a service in Edmonton. Telehealth services help to a point, but then default to "go to emergency." Primary-care health "teams" that share the burden of round-the-clock care are another option.

But we need to ask how serious is the problem. Emergency-room overuse is to be distinguished from the problem of long waits for those with severe complaints - those with minor ones go to the back of the line. These are the people who would go to a family doctor or nurse if one were available.

The problem, then, is largely one of annoyance and inefficiency, since emergency rooms are costly to run. Emergency-room overuse is best understood as a symptom of the shortage of family doctors generally, and especially after five o'clock in the evening and on weekends. It's mainly a sign that primary-care reform has stalled.

Roy Romanow wanted care to be available at 24/7 clinics, but his health-care commission of 2002, while prompting the creation of an $800-million fund for experimentation, did not produce lasting change.

Canada spends more on primary care and gets less than other countries, says Tom Noseworthy, a University of Calgary health-policy professor. He suggests imposing an obligation on medical professionals to provide after-hours and weekend care. But new obligations (or the re-creation of old ones) would not come cheap.

The cure for emergency-room overuse shouldn't add to the financial headache of medicare.