What are the challenges facing Medicare? Can we afford them?
Despite this highly organized distribution of health care provision roles between the federal, provincial and territorial administrations, Canada has faced a lot of challenges in its health care programs whereby the widening of the health care affordability gap has been witnessed. When we refer to the World Health Organization (WHO) 2001 statistics, Canada’s total disbursement on health service provision on Gross Domestic Product (GDP) expenditure is 9.5%, this is lower and slightly higher than that of the United States of America and the United Kingdom with 13.9% and 7.6% respectively, a grade which gives Canada 30th ranking in the world on the WHO’s year 2000 report on the cost efficiency of worldwide healthcare (Grzeskowiak, 2005). However, the health care service provision expenditures in Canada, in the recent past years are on the increase and since these expenditures are made from the public taxation as the major source of revenue, there is a lot to worry about on Medicare in the country. For instance, the expenditures increased by about 7.5% between the financial years 1999/2000 and 200/2001, and this was experienced as the overall proportion of health care expenses and those of prescriptions increased for patients but decreased for the medical clinicians.
Since the rural population in Canada’s northern territory is estimated to be approximately 30% of the entire country population and about 95% of Canada’s mass land is in the rural far away from the urban centers as in 2001 (Public Health Agency of Canada-PHAC, 2004), this has called for ways to improve the health care services in these rural areas where it’s poorly provided. People living in the rural areas in the provinces of Canada have shown that they are poorly accessible to the available health care services in their country. This is because of many factors predisposing these rural inhabitants to these kinds of behavioral characters, making them rarely seek the health hospital or physician intervention for the day-to-day check-up of their health status. The cardinal point for this particular occurrence is based on the following reasons which include; the fact that these people exhibit fewer healthy behaviors, for example, smoking and less-healthy dietary practices; they had a less likelihood to be physically active; their life expectancy is short for both females and males; they experience high mortality rates especially from cardiovascular and respiratory disease, diabetes, traffic accidents, and suicidal killings plus higher infant mortality rates (Herbert, 2007). Despite these disadvantages, most of the rural dwellers in Canada, who have minimum access to health care display small advantages over the urban population as those who are subjected to higher cancer incidences, are likely to report high-stress levels and reportedly lack a greater sense of community belonging.
The determinant of Medicare in Canada and also as the other challenge that faces the health care provider is illustrated in the underlying disparity of the rural area health, which is their socio-economic status as related to affordability of these health care services. They are entitled to low personal income, low educational knowledge, and skills, and higher unemployment levels, poor working conditions, poor personal health practices, and also the environment is unhygienic. Prevalence to disease and illness is consequential to apparent differences in rural environmental realities and as a result their health needs and usually such needs are dependent on the occupation and the environment, common health needs that are present only in a rural environment or changing demographics of the population. Also other challenges for the government of Canada to achieve the health for all targets is distance the rural people travel to get access to the modern hospitals and qualified health clinical officers. People in the rural areas where the infrastructure is not good are forced to travel very long distances in order to get these medical health care services, due to increase in distance between the people and the health care providers and institutions. Another discrepancy is that the rural dwellers comprise of the aged and the small children who usually require a lot of attention in their health care service provision and hence they require substantial health care programs due to a change in demand. There is also the widespread scarcely distributed population in most of these areas and at the same time there is a general diversity and lack of consistency of various health needs in rural areas but on the other hand information indicates that the health care needs for different particular groups are habitually not met, and always not clearly understood, in rural environments. Patients wait in queues to get health care services and this is commonly witnessed in diagnostic tests and surgical procedures. Other challenges include generation of overall healthcare funding; deficits in personnel and upgrading of medical technology; and the extension of the healthcare system to outpatients at homes, pharmaceutical and long-term care.
In the rural Canada, poverty levels are high and this has largely complicated the issues of poor accessibility, lack of well-established outpatient services and provision of health care service to the community by the health care officers. This is because there is a high indication of this as rates of infant mortality and low birth weights are high as studied by the Organization for Economic Co-operation and Development (OECD) in the year 2005. This, therefore, has revealed that despite the insurance policies on health care plans, there have been poor public policies on economic development which has been directly related to the health care outcomes in the society as the economic resources available are not distributed evenly among the Canadians. Again since good health care in any nation depends on the nutritional levels of their individuals and this is directly related to the levels of income, the people in rural Canada have been highly compromised by this for instance there are low birth weights and high child mortality rates in these rural areas.
What can (should) be done to improve health care in Canada (from all sources)?
Due to the several challenges facing the well-doing health care Medicare in Canada, there are ways in which the solutions for these problems can be solved by both the federal/territorial government and the entire community. First the federal government of Canada should work to the aim of protecting, promoting and supporting rural health care systems and this can be achieved when there will be coordination of the various interrelated factors which affect greatly improvement of the rural health care (Grzeskowiak, 2005). Nevertheless, since there is a constitutional authority of the federal government to fund provincial authorities as per the Canada Health Act, clear set national standards concerning financial contributions to sponsor the healthcare system should be given a clear definition, and this will avoid population health and health promotion approach of fund disbursement. The health care services, therefore, should not be based on the idea that there are health inequalities in the rural setup and thus leaders should take the front role in improving rural areas in the areas of research, expertise, education and coordination of provincial initiatives (CIS, 2008). These acts will offer a cohesive approach nationally, as well as initiate a federal/provincial partnership to focus on narrowing the existing discrepancy between rural and urban residents, eventually improving the health of all Canadians.
Secondly, there should be need for the government to redefine the rural health care plan, by changing the approach towards its health care delivery to its citizens. The state should recognize the health needs of the rural population and therefore be able to develop a common plan of action for these political coalitions. The main objective of this in the improvement of health status in the rural areas is developing a description that integrates the values and constructive attributes of a rural community, along with sustainable rural systems giving a skeleton for understanding the dynamism of rural health care requirements. On community-based solutions, the authorities have to facilitate a healthy community in the rural areas through providing a secure environment, supporting community participation, and formulating varied economies, sustainable ecosystems and accessible clinical services for these individuals. This will build the aspect of community in the sense that the local population will be empowered by understanding and trying to involve them in strengthening the capacity of local citizens to identify health and their challenges, give target priorities and take the necessary action. Another way of improving health care planning is through rural incentive plans, where there is facilitated good accessibility to the health care services. This can be achieved by the authorities recruiting and localizing such professionals to rural areas, since this has been a challenge being faced by many provinces but financial incentives offer some balance. However the issue should be addressed at the education level and preliminary preparation and rural-oriented learning programs and medical experience for both medical and nursing students is an efficient means of instruction and holding graduates in rural areas (Herbert, 2007). Also the utilization of the information and infrastructure technologies in the field of health care is of great effect as it has the potential to advance both wellbeing and the health care of the community inhabiting rural Canada.
Also since research on the health care systems in Canada has formulated that there is a disparity between rural and urban health care, and such divergence exists by stressing how conflicting determinants of health eventually generate diverse health needs with the identification of limited access to health care services as the major facilitator of health discrepancy for rural Canadians. On examining the primary health care model which is based on prepaid insurance, fundamentally is a deficit of efficient healthcare delivery more especially for rural residents, due to the available unfavorable trends in the medical field. The outlined solutions for these problems in health care thus can be solved for the residents of rural Canada and thus bridging the gap created through dealing with a redundant challenge which seems to need coordinated effort and change (Herbert, 2007). The concept of achieving provision for the “health for all” is the underlying strength in Canada’s healthcare system – reminder of such a fact has never been more relevant. Therefore the federal government should improvise ways of tackling the infrastructure for provision of health care service and evenly distribute the physicians in these areas especially redistributing the highly clustered medical officers in the southern urban cities.
By achieving the goals of the National Health Insurance Program in Canada which was designed objectively to ensure accessibility of residents to standard Health Care services necessities such as hospitalization and physician services, on a prepaid basis, there should be improvisation of even distribution of the federal government resources to the 13 units of territorial government based on their health care requirements. Funds for Medicare Insurance planning system should be distributed into the 13 provinces in the whole country as an alternative to developing a single national plan, and each of these individual provincial health Insurance Plans must lay down some common features and vital standards of health care coverage (Insurance-Canada.ca, 2008). This would avoid the over-distribution of health care resources to the highly populated and economically progressed urban areas especially areas bordering the US, and thus facilitate availability and affordability of the essential basic health care services and facilities.
And lastly due to the poor accessibility and affordability to the health care services needed by the people in Canada, its very significant for the Canadian federal government to restructure the health care system in a way to enable commitment in the reduction of waiting times in queues and inventing very strong initiatives in the improvement of access to diagnostic services. This will later on help the people in the efficient service received from the government through for instance the renewal agendas such as the one defined by federal, provincial and territorial first ministers in 2000 and 2003 form result-oriented health plan progress. The number of health care officers should be improved in the rural areas, as here due to poor economic development there has been a show of lengthy queues for gaining health care services especially most of the complicated operations in government hospitals due to low numbers of officers and facilities.
A case study for Saskatchewan pharmaceutical
In a new Saskatchewan (one of Canada’s territorial governments) the health care plan that I support, Health plan is assisting in a safer use of prescription drugs, because its Pharmaceutical Information Program (PIP) will grant certified health care professionals such as clinicians, nurses and pharmacists private access to the treatment records of their patients. The PIP is therefore a key tool for enhancing the safety of Saskatchewan’s health care system, as the program adds to the superiority, security, and administration of health care (NAPRA, 2009). People in the pharmaceutical industry can make use of this information and assist patients to maximize the benefits of their drug therapies, as the PIP will also enhance our role in promoting healthcare as members of the health care team. This has become efficient as the medical officers can be able to serve each of the inhabitants of the province regardless of their levels of income. In this state there is the implementation of a drug supply plan and this has facilitated the accessibility of health care, and thus improved standards of health of the people living here. Many poor people are given subsidized health care services plus the funds for hospitalization and physician check-ups a factor that has led to the enhancement of affordability to health care services unlike other territorial governing areas. The improvement of the state infrastructure which is the basis of Medicare development, has also facilitated the accessibility of thee services whereby compared to the rest of the health care plan in Canada (France St-Hilaire et al, 2008). Health care officers including clinicians and nurses have been encouraged by the state’s health care plan and allowances and they have increasingly been retained in these areas, leading to much better health care services. This therefore has led to good health care service provision to patients and long queues are not witnessed as seen in the general national health care provision institutions such as hospitals.
A case study of National pharmaceutical care
For the national Medicare in Canada where there is the disbursement of funds is made to the territorial government within each of the 13 provinces, I tend to oppose the general structure followed in the health care provision plan here. Despite the health care system in Canada being governed by insurance Medicare, where the government is the major sponsor of the health care services for its people, it has led to the development of the five basic principles in the Canada Health Act. This is to provide a kind of health care system that; is collectively accessible to stable residents of the area, expansively covers the entire health care services, is not subjected to the differences in the levels of income, is portable both from outside and within the country and also be publicly administered. The responsibilities of the 13 regional governments in providing hospital and physician services on a prepaid plan include; postulation of plans, financing and giving them hospital care, therapeutic care, enhancing public health, and even others assists in the process of dispensing prescriptions. Conversely, health care services coverage (i.e. dental care, hearing aids as well as prescribed drugs) has always varied between units. For instance, the Ontario unit has established its own prescription drug plans, which are the Ontario Drug Benefit (ODB) program and the Trillium Drug program, to facilitate the aged and others who are facing high costs of prescription drugs (Grzeskowiak, 2005). It has been noted that the prescription drug plans have always differed for instance, the Alberta as well as the Fair Pharmacare program that goes by the name British Columbia. But the entire program has indicated that in the rural areas unlike in the urban centers where there are many clinicians, the health care services are inadequate. This is usually due to the deficiency in the understanding of the health care needs of the rural inhabitants as seen above, by the federal government of Canada. Most of the areas in the rural areas are not covered well and thus in combination with poor infrastructure there has been the low-grade provision of health care services (Herbert, 2007). Also due to the federal government not being able to encourage the medical officers to re-locate to the rural areas where they see there is poor economical development, there has been a cluster of the health care provider in urban areas where living standards are high and affords to pay for services.
Quality of Medicare in Canada
In a general view, the quality of health care in Canada is fairly described to be one of the best in the world, but some issues have to be addressed for better health care planning. The high standards are shown by the ability of the government to deliver the best possible care and what has led to the achievement of the best possible results for people every time they deal with the health care system or use its services (St-Hilaire et al, 2008). Fundamentally, the health care system has led to the making use of the available resources for the betterment of Medicare for the Canadian people, as this has offered a high standard of services, with number one priority given to quality and patient safety. Health care in the 13 provinces/territories involves all the stakeholders such as health professionals and providers, researchers, agencies, policymakers and the public, which have improved the quality of health in Canada.
- Canada Health Infoway (CIS), new Pharmaceutical Information Program enhances patient safety: A new Saskatchewan Health Initiative on Pharmaceutical Information Program (PIP) (2008)
- France St-Hilaire, Christopher Ragan, Jeremy Leonard (2008), A Canadian Priorities Agenda: Policy Choices to Improve Economic and Social Well-being, Institute for Research on Public Policy, Edition: illustrated, Published by IRPP, ISBN 0886452031, 9780886452032, 573 pages
- Insurance-Canada.ca, Statistics and Reference Information from Canada: Towers Perrin Health Care Cost Survey Shows Average Annual Per-Employee Cost of $9,660 in 2009 — And the Health Care Affordability Gap Widens (2008)
- Mark Grzeskowiak, Health Care in Canada: an article by MedHunters (2005)
- National Association of Pharmacy Regulatory Authorities-NAPRA, Pharmacy Care Plans: Canadian Pharmacy Regulatory Authorities (2009)
- Rebecca Herbert, Canada’s Health Care Challenge: Recognizing and Addressing the Health Needs of Rural Canadians, Lethbridge Undergraduate Research Journal ISSN 1718-8482 (2007), volume 1