Health care silence

Posted by cwaddell under Election 2008, Election 2008 Student articles

 

Kristen Cucan

When Joan Roseboom answers the phone at the doctor’s office she works in, she’s often taking calls from people desperately looking for a family doctor, and almost every time, she has to turn them away.

“Every day I get requests from people who are almost begging me to take them as patients and we’re absolutely full up,” says Roseboom, a medical secretary for a family practitioner in Ottawa. Roseboom describes how many will even break into tears over the phone when she tells them they can’t accept them as patients. 

“These are people who need doctors, who are really sick and need care – and they just can’t find anybody,” she says.

When Roseboom’s own general practitioner retired, she says it took her more than a year to find another one – even with her connections in the medical community.

“I’m a healthy person, but for someone who has got serious health issues . . . and they don’t have a family physician, it’s a pretty darn scary situation,” she says. 

Survey after survey shows that Roseboom is not alone in her concern for the state of Canada’s health care system. With about five million Canadians without a family doctor, the doctor shortage is just one of many issues that have Canadians across the country thinking about health care as they head to the polls on Oct. 14. 

But while all the parties have made health care a part of their policy platforms, the topic has remained on the margins compared to other issues, such as the environment and the economy, which have dominated the headlines throughout the campaign. 

In an Angus Reid survey of 1,012 adults conducted for the Toronto Star before the election campaign officially started, 79 per cent of respondents said health care is “very important” when they decide which party gets their vote, with the economy coming in second at 75 per cent and the environment in third place at 61 per cent.

Another poll, conducted by Ipsos Reid for the Canadian Medical Association that was released on Monday, indicated that health care and the economy were virtually tied at 31 and 32 per cent respectively as the issue of most concern to Canadians. Other issues such as taxes and the environment came in at a distant second and third place. 

With the polls showing that health care is a high priority for most Canadians, the medical community has been critical of the main parties because of the silence they’ve been hearing on health issues.

 “It [health care] definitely hasn’t been on the forefront for the candidates. They don’t want to speak about health care and we’re disappointed about that,” says Dr. Robert Ouellet, president of the Canadian Medical Association.

And most Canadians seem to agree – the Ipsos Reid survey indicated that 74 per cent of Canadians think the parties aren’t talking enough about the issue. 

The survey also suggested 41 per cent of Canadians think federal leaders lack the vision to address such a complex issue and that another 30 per cent believe leaders are afraid to deal with the politically sensitive topic. The online poll surveyed 1,026 adults with a margin of error of +/- 3.1 percentage points, 19 times out of 20.

Hugh Armstrong, a professor who specializes in health policy at the School of Social Work at Carleton University, says part of the reason why political leaders aren’t making it a big election issue like it has been in previous campaigns, is because when it comes to the public-private health care debate, there is a general consensus.

“Medicare is Canada’s best-loved social program,” says Armstrong, who co-authored a book with his wife directed at the American audience, called Universal Health Care: What the United States Can Learn from the Canadian Experience. “Politicians of every stripe can read the polls and that’s why we have a consensus, at least at the rhetorical level, on medicare.”

With Prime Minister Stephen Harper declaring himself a supporter of Canada’s public health care system, he has blunted the political edge of this particular debate, Armstrong says. 

“The consensus around medicare is sufficiently broad and deep that it won’t become a major issue [in election campaigns] in the foreseeable future,” he says.

But he adds that privatization of certain health care services is happening in various provinces in bits and pieces – such as specialized privately-owned clinics that are popping up. This makes it hard for the opposition parties to articulate a position against privatization when it’s happening below the radar or “by stealth,” he says.

Another reason why health care isn’t a topic of focus, Armstrong says, is because the Conservatives likely calculated they couldn’t win on the issue, so they haven’t drawn attention to it in their campaign, he says.

In the 2006 election, the Tory platform focused on five main priorities, one of which was to implement a patient wait times guarantee, providing the provinces with specific targets to meet in five key areas – cancer, heart and diagnostic imaging procedures, joint replacements and cataract surgery.

While wait time measures show there has been progress in the five areas, Armstrong says the Conservatives were not able to deliver a lot of results.

“Basically what the provinces did was to meet a target which they had already met,” he says. “So, some more money went the provincial way but there wasn’t much change.”

Patient wait times is a politically charged issue that continues to top the list of health care concerns for Canadians.

The Wait Time Alliance, a group of medical specialists focused on improving timely access to care, has tracked progress made in wait times since 2004 when the 10-Year Plan to Strengthen Health Care was signed between the Martin Liberals and the provincial governments. Part of the $41.3-billion deal was to set out benchmarks for wait times. 

Some wait times have improved significantly, according to the Alliance. For cataract surgery (sight restoration), for example, it estimates that before the 2004 accord, wait times would have been given a grade of a C or D nationally. Today, the 2008 report card gives it a B grade. 

While progress is happening, it’s not occurring equally in all provinces and some benchmarks are still too low, the Alliance says. 

The group also notes that in many speciality care areas, wait times are still very long. For example, the median wait time for a patient to see a gastrointestinal specialist after their family doctor gives them a referral is 16 weeks.

But Roseboom says while some procedures have long wait times, she has found that if there is a life-threatening need to see a specialist, the patient will get timely access to care.

“When the chips are down and people really do have a serious illness, they do get help and they get it fairly quickly,” she says. 

 “I know the wait time for knee and hip surgery is terrible,” she says, “but I also know that I’ve had 30-year-old patients with breast lumps who’ve gotten in within a couple weeks and had their surgery done within a couple of weeks.” 

While the lack of significant results in wait times is a potential shortfall for the Conservatives, Armstrong says the opposition parties also have likely decided not to pursue the issue because they have determined it’s a problem too difficult to tackle, especially from the federal position. 

 “There is no single solution to wait times because of the complexity. These are wait times in complex systems,” he says. “It’s not the sort of thing that’s amenable to a sound bite on television.”

Allan Maslove, a professor who also specializes in health policy at Carleton University’s School of Public Policy and Administration, says he believes the main reason why health care is not a central plank in the party campaigns is that the parties feel the other issues – namely the economy – will ultimately have more impact on vote this time.

“What the parties think the voters are going to be voting on is who is going to be the best manager of the economy over the next couple of years, because the next couple of years are going to be pretty bumpy,” Maslove says.

“Even the Liberals’ environment plan, for example, is now being discussed as to what will be its short-term economic effects as opposed to what will be its environmental effects,” he says.

The dominance of the economy in the campaign was reflected in both leaders’ debates last week, in which the party leaders debated economic issues for 30 minutes out of the total two hours allotted. Every other topic, including health care was given 12 minutes for debate.

Armstrong says fears about an uncertain economy will probably continue to overshadow health policy in the mandate of the new government.

“I think in terms of health care, this will probably mean that most [MPs] will be cautious about the introduction of new programs,” Armstrong says. “Because why would you do that when you’re not even sure you can afford the existing programs?”

While health care hasn’t been central to the election campaign, the parties haven’t ignored it either – all the major parties have included health care as an important component of their platform. 

Up until this week, the Conservatives had not made any new health-related announcements. But in their platform released on Tuesday, the party  introduced its plan to address the doctor shortage by funding new residency spots in teaching hospitals and creating a $5-million incentive fund to encourage Canadian doctors practicing abroad to return home. The party also promises to establish pilot projects to recruit and retain more nurses.

Key health planks in the Liberal platform include a plan to spend $900 million over four years to create a national catastrophic drug coverage plan. 

The Liberals also promise to spend $420 million to establish a Doctors and Nurses Fund to help ensure Canadians have suitable access to health care. Among other initiatives, the fund will be used to help train more medical professionals. 

As well, the party plans to forgive $10,000 in student debt for graduates who agree to set up their practice in an under-serviced community for at least five years.

The NDP has promised to introduce a $2.5 billion home-care plan over four years to allow families to take care of seniors in their homes. Leader Jack Layton also announced a $1-billion plan to train more doctors and nurses.

As well, the party will forgive student debt for medical graduates who commit to working in family medicine for the first 10 years of their practice.

The Green Party has expressed its commitment to universal public health care and the Canada Health Act. The party plans to expand home-care programs and transfer more funds to provinces to create additional long-term beds for seniors. 

It also wants to create a national pharmacare program, focus on preventative medicine and establish a national program to promote active living.

While most parties are promising to help address a variety of health care issues, the growing problem the medical community is strongly urging governments to fix is the widespread shortage of doctors and nurses.

In Canada, the physician-to-population ratio is about two doctors for every 1,000 people. This figure places Canada 26th out the 30 industrialized countries that belong to the Organisation for Economic Cooperation and Development. 

Dr. Qais Ghanem, a physician specializing in sleep medicine, is running for the Green Party in Ottawa South. As a member of the Canadian Medical Association, he has been actively involved in lobbying the government to meet the need for more medical staff in Canada.

Ghanem says the problems of wait times and doctor shortages currently facing the system are only going to get worse as the baby boom generation reaches retirement. The general population is aging and so is the medical profession. 

The medical association reports the average age of a physician is 50, and that 30 per cent of doctors are over 55 years old.

“So the demand is increasing,” Ghanem says, “and the supply is decreasing.”

Joan Roseboom says the lack of family physicians is a particular problem because it causes more people to clog up emergency rooms with minor problems, such as fevers and ear infections.

“People complain about having to go to emergency to sit there for hours and hours and hours,” Roseboom says. “Well to me that’s because there are so many people going there who really shouldn’t be there in the first place.”

Dr. Robert Ouellet says even if the doctor shortage is fixed, there are still other health problems to solve. Health care is a complex policy area, he says.

“It’s a tough issue, but there should be leadership from political leaders and they’re not doing that,” he says. 

Maslove says it’s no accident that health care, as a traditionally provincial responsibility, has been a hot-button issue in the last few federal elections. Even if a party isn’t doing anything for health care, he says leaders have to appear as if they are concerned.

“Despite what the constitution says,” Maslove says, “people obviously take the view that the federal government has some role to play in maintaining the health care system.”

Kristen Cucan is a fourth-year student in the Bachelor of Journalism program at the School of Journalism and Communication at Carleton University.