Health care system ailing



(November 12, 1998)
By Sharon Gray

Like a shiny car that looks good on the outside, but belches black smoke and drips oil, Canada's health care system is not in good shape.

In fact, it's not a system at all, according to Dr. Duncan Sinclair, chair of Ontario's Health Care Restructuring Commission.
"We have 10 provincial and two territorial ‘systems' loosely coordinated by virtue of the fact that their basic characteristics qualify under the Canada Health Act for just enough federal funding to make staying in line worthwhile."

Dr. Sinclair's remarks were made during a talk Nov. 6 at the medical school as part of the faculty's 30th anniversary celebrations. He said that Medicare is Canada's most cherished social program and we have to think carefully about where we want it to be in the future.

"Canada's so-called health ‘system' has few characteristics of a genuine system because the parts are not coordinated and don't work well together. It is lopsided, with health care overwhelming the other determinants of health."

Medicare, said Dr. Sinclair, deals almost exclusively with sickness care.

"Our so-called system is good, excellent even, in ensuring access to high quality health care by doctors and hospitals. But how good is the ‘system' if you define health as something closer to the ideal articulated by the World Health Organization — a resource for daily living?"

The answer to that question is unknown, and that's a serious problem.

"The greatest threat to Medicare and to the development of the broadly focused health services system we must create to meet the challenges of the 21st century is the lack of good data, information and knowledge. A great place to start would be with some sensitive, comprehensive measures of the health status of the population."

As an example of how inadequate the health information system is, Dr. Sinclair said that a patient can visit half-a-dozen physicians in a day, a hospital emergency room, a chiropractor, an immunization clinic, a rehabilitation clinic and several pharmacies to fill prescriptions without any of the providers knowing anything about the visits elsewhere unless the patient tells them.

Canada's universities and particulary medical schools have been "derelict" in their responsibility to offer intellectual leadership.
"We don't even have a clue how to measure the total benefit to the Canadian population of spending $78 billion dollars of public and private money each year on health services."

Dr. Sinclair said that as Canada's population ages and the fiscal realities of balanced budgets remain, the current health care system cannot be sustained.

"We are in serious danger of not serving the future well."