Why is this?
"It is because...you have to be prepared at any moment to face difficulties and even dangers by knowing what to do and how to do it" ...Agnes and Robert Baden Powell
As someone who uses the services of health care on nearly a daily basis it is critical to me to understand what the future of health care might look like. In other words I (and many others like me) need to "Be Prepared."
Dramatic Change is Unlikely
Many in this country are deeply invested and proud of our "universal" medicare system. Make no mistake the concept of universal health care is noble. Access to health care based on need and not on financial or social standing is worthy endevour. Unfortunately, we live in a less than perfect world and there are realities to consider. In other words...how do we pay for it?
How health care is delivered is an emotionally charged topic that nearly everyone has an opinion, regardless of their knowledge of the health care system. If we aren't using the health care system now, it is likely we may need it at some point in time. Health Care matters.
There are heated debates that have been ongoing for many years. Proposals about maintaining medicare in its current form, the possibility of privatizing some components of health care, or moving to a public-private hybrid similar to some countries in Europe. The discussions tend to get emotionally charged and in many cases are ideologically driven. To be honest I am tired of the arguments. The debates have been going on for years and I don't see them ending any time soon. Numerous reports and commissions have outlined cures for our health care woes. At this point any new efforts to study the issues in Canadian Health Care is essentially a recycling of old issues and old recommendations. Canadian Health Care has been studied to death. Pardon the pun.
Due to the contentiousness of health care and how polarized our society has become; I doubt any kind of consensus would ever be reached regarding any fundamental change or improvement in the direction of health care. It does seem to be the hill some people are willing to die on.
All of this hand wringing does not help any patient dealing with health care is its present form. What can you do now to prepare for the future? What will the future look like? Here are a couple of thoughts to which I hope I am wrong, but I think are harsh reality.
What May Change in the Future
To be honest. Not much.
Health Care as it stands is controlled by a complex bureaucracy, that in one way, shape, or form eventually reports to government.. Government ultimately holds all of the policy and financial cards. The challenge in making any substantial shift in health care policy is that change, on a large scale, can be potentially suicidal for any government. Even if one province were willing to go rogue and make substantial change they could face stiff opposition from the federal government who can restrict funding to the provinces. The point I am making is that any change in health care policy will bog down in government bureaucracy and political infighting.
We have built a system that instils stagnation...not innovation. That has absolutely nothing to do with medicare or two tiered health or whatever rhetoric you choose to employ. It has to do with our current system which flat out refuses to change or when changes are made it moves at a glacial pace.
No one denies that health care costs are increasing and will only continue to rise. Presently, there are many gaps in our health care system that require additional funding. Things like mental health care or palliative care to name just a couple. Currently, health care represents nearly half of provincial budgets. Provinces can't afford any more. The federal government has its own financial issues and funding levels will likely remain the same in the foreseeable futures. Any large increases in health care spending will require increasing government debt or reducing budgets in other areas of government. Given these alternatives it is likely that health care will meander aimlessly into the future with no clear direction or solutions being implemented. Much like it has for the past 15 to 20 years. Status quo.
Results of the Status Quo?
What has been happening in recent years in health care policy? The trend for many years has been a slow retraction of health care services. Very slowly and very methodically services in health care are slowly becoming more restrictive. Everyone is feeling the squeeze. These are subtle changes that politicians hope no one will notice or that the opposition will be temporary. All governments do this - regardless of political affiliation. Services that were once covered by our health care system are no longer available. It starts with small things. Follow up from hospital stays, such as home care, occupational therapy, or physiotherapy. It's subtle. May only affect a few patients, so it easily flys under the radar. Certain prescription medications can be removed from the pharma care formulary (if you live in a province with pharma care). User fees for services can increase. Community programs once subsidized by the health care system are eliminated. Additional pressure is placed on those employed in health care. All aspects of health care are under tremendous pressure to do more with less. Some of these ideas are good (nothing wrong with being more efficient) but what it has some unintended effects. If "improvements" are done poorly they can stress health care resources and make the margin for error within health care increasingly small. With an extremely small margin of error, patient safety is being put at risk. This is real and it is happening today.
What does this mean for the patient? Increasingly, patients are left to struggle within a system that is bursting at the seams. As patients have no say in health care policy, how patients access the system is an afterthought. When changes are made for the sake of "efficiency" patients are often the last people to be considered. If at all. We've stopped trying to have an excellent health care system...we are now just hoping our health care system will survive.
How to Survive
One of the fallacies of our "universal" system is that health services are free and that the system will be there when we need it. We need to understand that this is just not true. Many services are accessed with simply presenting your health care, but many are not. This comes as a shock to many people the first time they encounter this reality. However, having to pay for service is far from the biggest frustrations that patients deal with in health care. The biggest challenge by far is trying to access it. How do health care bureaucrats manage costs within our system? They simply restrict access to it.
One of the most difficult things you will do in being a health care advocate is gaining access. There are road blocks everywhere. Wait times, endless referrals, silo mentality, archaic technology, restrictive policies, incomprehensible terminology, and flat out being ignored; are all rampant in health care and serve to restrict patients' access to health care services. The bottom line is that being an effective advocate requires a great deal of skill. If you don't have these skills you need to learn them.
The public needs to educate themselves. If you are unfortunate enough to require long term health care services becoming an advocate for yourself or a loved one is not optional. How long are you willing to wait in an Emergency Room before you get up and walk over to the triage nurse and ask how long the wait might be? Can you negotiate your way to getting quicker service? Do you have a phone number or email address to contact a clinician if you have a question? Do you carry good health insurance to pay for physiotherapy after you injure your shoulder? Do you even know what is in your extended health coverage that you blindly signed up for when you took a new job? These are all things you NEED to know. It is not optional.
Only the Strong Survive
One of the most disturbing realities about what I have stated above, is that not everyone is capable of this level of advocacy. I am very fortunate. I have health coverage that is paying for private services. I have a job where I have a flexible enough schedule that I can take my family members to medical appointments. We have had a strong network of friends and family who pitch in and help out. The amount of support we have received has been amazing. The unfortunate part is that not everyone has the kinds of supports we do. Many people in our country lack many supports and services. They can't access health care services because they lack the skills, time, and energy to advocate for themselves.
Is it any surprise that the people with the skills to access health care services, are usually people with "means" who have the time, financial resources, and education to be skilled advocates?
Are you prepared to face your health care reality?