Jane Philpott has a Big Idea to fix Canadian health care: treat access to a family doctor just as we do public education.
When a family moves to a new town, their kids do not go on a years-long waiting list for a new teacher. They do not take a bus back to their old classrooms because of a local shortage of teachers. Instead, they get a desk and an education.
Dr. Philpott – a physician, former federal health minister and now an academic – argues that the same should be true of health care, with Canadians being guaranteed a spot in a primary-care centre that has doctors and other health professionals.
By itself, that idea is not much of a revolution. But it’s the way in which Dr. Philpott, now dean of health sciences at Queen’s University, would have Canada pursue that goal that sets her Big Idea apart – and is a model for how policy makers should approach health care reform.
For a start, she concedes that the health care system is not working, not when 6.5 million Canadians, or about 22 per cent of the adult population, do not have a family doctor or other primary health care.
“We would never tolerate a status quo in which only 80 per cent of Canada’s children were able to attend school,” she writes in her book, Health for All.
That is a refreshingly candid assessment, and the necessary start to any meaningful discussion on health care reform.
An unhealthy debate
This is part of a series on our health-care system, and the challenges in diagnosing and fixing its problems, as explored in The Globe’s Secret Canada project. Follow our editorial page for new instalments.
Broken promises: The ‘universal’ model is anything but
Data: Lack of clarity is unacceptable
Lessons from abroad: Health care, Australian-style
Justice: Defining the duty of care
Dr. Philpott has (conspicuously) gone shopping for ideas from other countries. Her primary-care pitch mirrors the current reality of the Netherlands, where she notes that 95 per cent of Dutch citizens are registered with a family doctor.
The Dutch have lessons to teach Canadians, undoubtedly. According to the U.S. non-profit group The Commonwealth Fund, the Netherlands outperforms Canada on a number of health care metrics, most notably in equity, or the gap between the health care experiences of poorer and richer citizens. Canada ranks seventh out of 10 countries. The Dutch universal health care system – in which people are required to have private insurance – ranks third.
Dr. Philpott chose to focus on the Dutch model of primary care. Others might be more interested in how the Netherlands achieves health care equity alongside patient-paid services. Either way, the standard to measure proposed reforms should be: what country does the best job, and how can that lesson be applied in Canada?
Most important, Dr. Philpott is unafraid of challenging the status quo.
Doctors in Canada have complained, legitimately, about the pressures of the current fee-for-service model, and the administrative burden of operating as a small business. The status quo creates a hamster wheel of activity centred on churn rather than engaging with patients, and an impossible work-life balance. The result has been a shortage of MDs, driven in part by newer doctors opting not to work the long hours of their predecessors.
Dr. Philpott’s primary-care centres would centralize administration, easing doctors’ paperwork burden. That would undoubtedly be met with applause. But such a system would curtail doctors’ prerogatives as well. Physicians would have less control over which patients they saw and, most likely, would be paid a salary rather than billing the government. The applause for those changes would be somewhat fainter, at a guess.
There are pluses and minuses, but the key point is this: reforms that focus on defending the status quo are simply reinforcing failure.
Dr. Philpott gets one other thing right with her Big Idea – namely, setting a specific goal (100 per cent of Canadians have access to primary care) with a deadline (by 2035). Progress toward that goal would be continually updated and easily accessible to the public.
One needn’t agree with every facet of Dr. Philpott’s plan to see the merits in how she has fashioned her proposal for dealing with the sad failure of millions of Canadians not having a family doctor. Health care reform that sets bold goals and is unafraid of moving past today’s failures: that’s a big idea indeed.