Why changes need to be made for the Canada Health Act to reflect the current climate of health care needs in Canada
The Saskatchewan Hospitalization Act of 1946 (SHA) was the original universal health care legislative act that the Canadian Health Act of 1984 was built upon. The SHA established and required that all hospital and diagnostic services are provided free of charge to residents of the province (Flood and Thomas, 2016, p.400). This policy led to the creation of the Hospital Insurance and Diagnostic Services Act (HIDSA) of 1957 which was essentially the first iteration of the Canadian Health Act. The HIDSA was created in the hopes to incentivize other provinces to follow Saskatchewan’s lead of offering free hospital care and diagnostic services. The federal government’s legislative act offered 50/50 cost-sharing to all provinces with similar health care models as Saskatchewan (Flood and Thomas, 2016, p.400).
Over the 1960s and 1970s, other revisions and acts were established to further develop and shape heath care in Canada. In 1984, the CHA was developed and remains the current iteration of what health care in Canada encompasses. The Canadian government however have failed to modernize the CHA and its limitations. The CHA limits coverage to “medically necessary” hospitalizations and physician services. The CHA does not include universal drug care, dental care, long-term care and mental health services (Flood and Thomas, 2016, p.398). As a result, the CHA fails to allow for the changing health care climate, specifically for the aging population and chronic disease management (Flood and Thomas, 2016, p.399).
As a Respiratory Therapist (RT), many patients are regularly admitted into the emergency room for Chronic Obstructive Pulmonary Disease (COPD) and Congestive Heart Failure (CHF) exacerbations. These patients often suffer these health incidents due to the gaps in coverage outlined in the CHA (Flood and Thomas, 2016, p.402). The lack of a universal drug coverage under the CHA often leaves many patients struggling to obtain the drugs prescribed to them. As a result, these patients often end up in hospital requiring treatment and putting a financial burden on the health care system. In 2000, Canada chronic diseases accounted for $99.1 billion with $31.6 billion being associated in direct costs (BC Ministry of Healthy Living and Sport, 2010, p.4-5). These numbers have only risen and it is estimated that chronic diseases account for $190 billion annually with $68 billion of it being a direct cost (Chronic Disease Prevention Alliance of Canada, 2018, p.1). Most of the direct costs are due to chronic diseases that can be prevented and mitigated.
In Fraser Health, we are fortunate enough to have Community Respiratory Services. This program employs community RTs who specifically provide chronic disease management, education and support to people living with COPD (Fraser Health, 2021). The RTs help patients quit smoking, optimize the use of medications and other therapies to reduce symptoms, help educate patients to recognize COPD flare-ups and how to initiate self-management for COPD flare-ups. Additionally, they help determine when patients should seek medical attention (Fraser Health, 2021). This program provides patients in the community the support they need with the hope of reducing frequent hospitalizations. Community RTs also provide support to patients in the community living with a tracheostomy. The RTs will provide assistance with making sure the trach stoma is healthy and patent, provide further education. Programs like these aim at reducing the direct cost placed on our health care system by chronic diseases. Consequently, programs like these tend to have strict guidelines and are heavily underfunded. For community respiratory services, you must be diagnosed by a physician with COPD and referred by either a physician, nurse practitioner or any other health professional to the program (Fraser Health, 2021). From my personal experience, many patients that would benefit from these kinds of programs get missed. Some patients do not fit the requirements, others refuse to participate and sometimes health care practitioners do not refer potential candidates.
Society is always evolving and changing. Ideologies that worked in the past do not always continue to work in the future. In the 1980’s and 1990’s, the ideology of “medical necessity” set forth under the CHA may have worked but with an aging population now in the 2000’s, reform around what is considered “medical necessity” is needed. In British Columbia alone, over half of the population has at least one chronic condition and in the province chronic diseases are responsible for the majority of deaths (BCCDC, 2018, p.3). The CHA needs to amended the definition of “medical necessity” to be more reflective of the current climate in heath care. Having access and coverage for prescription drugs is a “medical necessity” in the eyes of people living with chronic diseases. The lack of universal drug coverage causes many low-income Canadians to avoid or delay seeking care because of the fear of costly prescriptions (Flood and Thomas, 2016, p. 403). Ultimately, these patients arrive in the emergency room of hospitals requiring medical attention that costs the heath care system more. Yet politicians are more concerned with driving down the cost of drugs before they would even consider a publicly funded drug coverage (Flood and Thomas, 2016, p. 409).
Modernizing the CHA will require frequent reviews and updating that keeps up with the emerging needs in Canadians. A good starting point is expanding the CHA’s coverage to include prescription drugs, diagnostics, mental health (psychology), home care and dental care (Flood and Thomas, 2016, p. 409). Additionally, CHA needs a taskforce that consistently reviews the needs of Canadians and determines what services are needed or no longer needed under the CHA (Flood and Thomas, 2016, p. 409). Health is not stagnant and our CHA shouldn’t be either.
References:
BC Centre for Disease Control. (2018). The Economic Burden of Risk Factors in British Columbia, 2015. BC Centre for Disease Control. Retrieved January 23, 2022 from http://www.bccdc.ca/pop-public-health/Documents/economic_burden_five_risk_factors_BC_2015.pdf
BC Ministry of Healthy Living and Sport. (2010). Model Core Program Paper: Chronic Disease. BC Ministry of Healthy Living and Sport. Retrieved January 23, 2022 from https://www2.gov.bc.ca/assets/gov/health/about-bc-s-health-care-system/public-health/healthy-living-and-healthy-communities/chronic_disease-model_core_program_paper.pdf
Chronic Disease Prevention Alliance of Canada (2018). 2018 pre-budget submission to the House of Commons Standing Committee on Finance. Chronic Disease Prevention Alliance of Canada. Retrieved January 23, 2022 from https://www.ourcommons.ca/Content/Committee/421/FINA/Brief/BR9073636/br-external/ChronicDiseasePreventionAllianceOfCanada-e.pdf
Flood, C.M, & Thomas, B. (2016). Modernizing the Canada Health Act. Dalhousie Law Journal, 39(2), 398-411. http://charon.athabascau.ca/cnhsgrad/mhst601_w2018/unit2.htm
Fraser Health Authority. (2021). Community Respiratory Services. Fraser Health. Retrieved January 23, 2022 from https://www.fraserhealth.ca/Service-Directory/Services/home-and-community-care/community-respiratory-services
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