Improve public health care rather than explore private alternatives, say patient advocates

Patient advocates invited by the Canadian Medical Association to talk about public and private health care in Canada made their views crystal clear, according to a report of that three-hour meeting on Jan. 24 in Halifax.

"It was strongly recommended that before exploring and implementing other options, we must first diligently work to try to ensure there is timely access within the existing [publicly funded] system," noted the summary of the meeting.

"Many participants felt that exploring alternative options to care was a distraction from addressing the fundamental, systemic issues within the health-care system, such as the lack of access to primary care."

The Halifax gathering was one of 17 "focused dialogues" organized by the CMA to hear from people working in health-care. The group also hosted public town halls in Toronto, Montreal, Vancouver and Halifax to coincide with the focus group sessions.

Donna Rubenstein, a Nova Scotia Health patient family adviser, was grateful to the CMA for holding the meeting. 

"I really want to commend the CMA for having the discussion and bringing people with lived experiences to the table," said Rubenstein. "That's critical and that hasn't happened before."

'Like baking a cake'

Rubenstein said people want to be part of redesigning the system to make it more patient-focused and responsive to their needs and that of their caregivers. 

"It's like you're baking a cake," she said. "You want to be there when you're deciding what cake you're going to make, what the ingredients are.

"Don't call us in when it comes out of the oven to decorate it."

 Rubenstein was impressed by the "robust" discussion and what appeared to be the consensus view. 

"What I heard is we have to rethink how we look at health care and how we deliver health care," said Rubenstein. "The model we've been working on is outdated. So much has changed and the health-care system hasn't adapted with it."

Dr. Margaret Casey, a long-time family physician, also came away from the meeting with a feeling of admiration.

"People had some very good ideas, very well expressed concepts and comments," said Casey. "Clearly this is a top of their mind issue."

Casey was also gratified that the downtown Halifax clinic where she worked for 25 years was singled out in the report.

"The North End Community Health Centre in Halifax and the Millbrook Health Centre in Truro were cited as promising examples of interdisciplinary primary care teams working together to effectively serve patients in the community," the report said.

"If we're going to approach prevention of disease and improving health, we need a team approach," said Casey. "It's too wide a range of work, of details and of background that they need their own areas of expertise."

Participants focused on public system

When it comes to private medicine, Casey said she understood why that option might be attractive to those who could afford to pay out of pocket for some services.

"There's no question that if we have a loved one who is ill and needs care and can't get it in the public system we would go to the private system," she said. "People are at that stage, if they have to see somebody and they can afford it, they'll do it."

Casey was glad most of the dozens of people who attended the session seemed to be on the same page, focused on the public system rather than looking at further expanding private options.

"Inevitably it evolves into a two-tiered system so there's no question that people who can't afford to pay for private care don't get the care that is equal to the ones who can."

The CMA isn't yet ready to talk publicly about what it has learned during this process. 

"We can't accommodate an interview at this time," wrote Eric Lewis, the CMA's senior adviser on media relations. "Following the series of conversations about the role of private care, the CMA is intending to produce a report of the findings, what we learned through the consultations, etc.

"We'll then be in a position to discuss it."

The association is planning to use these consultations to "help shape CMA policy and advocacy at a national level."

According to Lewis, "There were more than 649 virtual attendees and 103 in person in Halifax."