Six Challenges FacingCanada’s Health Care System

An event organized by Canada 2020May 25, 2011

By Michael Kirby

Chair Mental Health Commission of Canada

Challenge 1

Convincing Canadians that the health care system is not financially sustainable.

Facts about the growth of health care costs (from a recent paper by David Doge and Richard Dixon):

For the past 35 years health care expenditures as a percent of GDP have risen approximately 0.15% per year

Challenge 1 Continued

A similar pattern is likely to continue into the future because of: The aging of the population The growth in pharmaceutical costs Technological advances

Average growth is forecast to be 5%-7% annually, much less than the rate of increase of government expenditures.

Challenge 1 Continued

Health care expenditures as a percentage of GDP increase from 12% in 2009 to 18.8% in 2031

Even with system efficiencies, the ratio is 15.5% in 2031

Challenge 1 Continued

Challenge 1 Continued

5.007.009.00

11.0013.0015.0017.0019.0021.00

Projected Health Care Spending/GDP Ratio (%)

Optimistic Case Base Case

Challenge 2

Convincing Canadians that some of their central beliefs about the health care system are not true; they are myths.

For example: A Universal health care system does NOT need to be FREE. Canada is the only

country with a universal health care system in which co-payment of some kind is not paid by at least some citizens.

Medicare was created to be a public health services INSURANCE program, NOT a public health services DELIVERY system.

The current health care system is not entirely publicly funded. Only 70% is publicly funded, the remaining 30% comes from private sources, mainly individuals.

These myths severely constrain public discussion of health care issues in Canada.

Challenge 3

Determining whether Canadians want challenge 1 solved by:

a) increased taxes which governments put into the health care system;

Or

b) individuals putting money directly into the system through, for example, a co-payment for certain services or buying health insurance to cover some, or all, of the services which are currently “free”.

Challenge 4

In the answer to challenge 1:

If a) is chosen, what type of taxes do Canadians want increased

If b) is chosen, what direct payment system do Canadian prefer;

And

how to Canadians want the fairness of the current system preserved (eg. The quality of health care a Canadian receives must not depend on an individuals’

income).

Challenge 5

In addition to increased funding, the health care system must also be made more efficient

Making the current health care system more efficient requires VERY significant structural change, no matter which set of proposals for change are adopted

System change is frequently strongly opposed by people employed in the system and the organizations they work for. The health care system is no different.

How can such opposition be overcome?

Challenge 6

If the health care system is to meet its original objectives of covering all health care services, and live up to the principles of the Canada Health Act, two system expansions are required:

A) prescription drugs

And

B) clinical counselling (talk therapy) by mental health professionals outside of hospitals other than psychiatrists (eg. psychologists, social workers etc.)