Jeffrey Turnbull, president of the Canadian Medical Association, is shown at the Ottawa Hospital on March 25, 2009.Brigitte Bouvier for The Globe and Mail
Canada's doctors are urging Canadians and their politicians to begin an urgent national debate to ensure the survival of a public health-care system that is being crushed under a growing financial burden.
Federal Health Minister Leona Aglukkaq concluded a meeting with her provincial and territorial counterparts on Tuesday and reached a consensus on ways to improve the wellness of Canadians - proposals she said are designed to prevent illness that will ease the burden on the system down the road.
But Jeff Turnbull, the president of the Canadian Medical Association, said sustaining the public health system will require politicians to start a much broader discussion.
Federal and provincial health-care funding agreements are set to expire in 2014, Canada is in a period of financial constraint and the aging demographic suggests demands on the system will grow rapidly in coming years.
With those issues on the horizon, "we want our federal and provincial politicians to start thinking about sustainability and to get engaged in the conversation," Dr. Turnbull said.
Health care cost Canadian taxpayers an estimated $183-billion last year, according to the Canadian Institute for Health Information. It currently accounts for 42.1 per cent of all government spending and continually outpaces all other areas of public expenditure. For years, public health professionals have been under pressure to cut costs.
Ron Kneebone, an economist at the University of Calgary's School of Public Policy, said that, based on projections, the percentage of government spending eaten up by health care could climb to 80 or 85 per cent by 2030.
"We're going to be in dire straits trying to fund things like higher education or social systems or just basic education, when we're spending 80 or 85 per cent on our budget on health care," he said.
But Dr. Turnbull said Canada's doctors believe sustainability of the health-care system means more than just fiscal restraint.
There are already problems with the system, including waiting times and accessibility, Dr. Turnbull said. "I don't want to cut costs on a system that is already broken."
The doctors also say there are many ways to improve health care that could also result in cost savings.
Creating a system of electronic medical records would not only be economical in the long run, it would improve patient care and safety, Dr. Turnbull said.
So would moving chronically ill patients out of critical-care beds into long-term care or home care, he said.
At the Ottawa Hospital where Dr. Turnbull is chief of staff, 150 patients were in acute care beds on Tuesday who did not belong there, each of which costs taxpayers $1,000 a day. Long-term care and home-care cost a fraction of that, Dr. Turnbull said.
Then there is pharmacare. A report this week by the School of Public Policy at Carleton University said a national program could slash more than $10.7-billion off Canada's $25-billion-a-year drug bill.
These things are ideas that must be debated, Dr. Turnbull said.
"All health professionals have to get engaged, the public has to be engaged, and we have to get behind the politicians and get them to move on it."
The CMA released a report earlier this summer entitled Health Care Transformation in Canada: Change that Works, Care That Lasts that outlines prescriptions for change.
Deb Matthews, Ontario's Health Minister, said she shared that study with her counterparts around the table at Tuesday's meeting. Ms. Matthews said she was impressed by its recommendations.
"We have spent a considerable amount of time at this meeting talking about issues that really do improve the value we get for the money we spend on health care," she said, including common drug procurement and purchasing of medical supplies.
But Livio DiMatteo, an economist at Lakehead University in Thunder Bay, who has written extensively about the sustainability of the health-care system, said in an interview that any real discussion will require politicians to accept that they may have to make unpopular choices.
Health-care costs will go up, Dr. Di Matteo said. Even proposals like increased home care are not cheap, he said.
"The question is not whether you are going to spend more," he said, "it's whether you are going to do it through a public system or have more of a private role."