Health Care Reform and Older Adults

Health care is an important issue for older adults.  As we all live longer, we are more likely to face complex and chronic medical conditions, and require greater health care. There are also more of us moving into our retirement years with the Baby Boomer bulge.  The federal, provincial and territorial health ministers are meeting to discuss a new ‘Health Accord.’  Many of the funding priorities that are on the table are important to older adults.  Here is the list of the federal government’s priorities for a new Health Accord:

  • a new long term funding agreement
  • support the delivery of more and better home care services. This includes more access to high quality in-home caregivers, financial supports for family care, and, when necessary, palliative care;
  • advance pan-Canadian collaboration on health innovation to encourage the adoption of new digital health technology to improve access, increase efficiency and improve outcomes for patients;
  • improve access to necessary prescription medications.  This will include joining with provincial and territorial governments to buy drugs in bulk, reducing the cost Canadian governments pay for these drugs, making them more affordable for Canadians, and exploring the need for a national formulary; and
  • make high quality mental health services more available to Canadians who need them.

from the Prime Minister’s ‘mandate letter’ to the federal Minister of Health

But things are not going well.  The Ministers have gotten stuck on the first bullet point – with the feds wanting to limit the annual funding increase to 3%, while the provinces want to maintain the 6% annual escalator from the previous Health Accord:

“The provincial, territorial, and federal health ministers have a historic opportunity before them.  Medicare is at a crossroads and we need to put the health of Canadians first as negotiations progress. The health of our friends, families, and communities is too important for the reckless game of chicken that is happening between the federal and provincial governments.”                                                         – Michael Butler, Council of Canadians


CMA Platform on Health Care Reform

In October of 2016 the Canadian Medical Association released their ‘platform’ on what should be included in the new Health Accord: Improving the Health of All Canadians: A Vision for the Future.

“Canada’s doctors and the patients we serve have watched and read with growing concern the media reports describing how our political leaders are establishing their opening positions for negotiating a new Health Accord,” said Dr. Granger Avery, CMA President. “Renewing our Canadian health care system requires a modern, collaborative approach that builds on existing silos of excellence.”

The CMA’s platform includes the following six recommendations of what it believes should be included in any new health accord.:

  1. targeted extra funding as a “demographic top-up” for provinces and territories with more seniors;
  2. coverage for highly expensive medication so that Canadians do not experience undue financial hardship if they are sick;
  3. more financial support for family caregivers by making tax credits refundable;
  4. a national strategy for palliative and end-of-life care;
  5. a coordinated home care plan so that healthy seniors can continue to live in their homes and get the support they need; and
  6. key infrastructure investments to improve and provide more long-term care for Canadians who need it.

See the infographic from the Canadian Medical Association above-left for the views of Canadians on some of these issues.

cfpc-patients-medical-home-enPatient’s Medical Home

One of the more interesting proposals for reforming health care is the idea of a ‘patient medical home.’  The word ‘home’ here is used to suggest most if not all of the medical services for a patient should be housed in one place.  Sort of ‘one-stop shopping’ for medical services.  A primary care physician would be part of a medical team in a combined practice or community health centre.  This is seen as leading to much more efficient collaboration, and more effective use of the latest technology.

The College of Family Physicians of Canada has developed a Vision for Canada Family Practice – the Patient’s Medical Home.

They suggest that a family practice can be ‘transformed’ into a Patient’s Medical Home by meeting the 10 goals set out in the infographic above:

  1. Patient-Centred Care
  2. Personal Family Physician
  3. Team-Based Care
  4. Timely Access
  5. Comprehensive Care
  6. Continuity of Care
  7. Electronic Medical Records
  8. Education, Training and Research
  9. Evaluation and Quality Improvements
  10. Internal and External Supports

Patient Medical Homes in BC

Image result for flag BCBC is now moving forward with plans to initiate team-based primary care province-wide:

  • patient’s medical homes (PMH) and,
  • primary care homes (PCH).
Patient Medical Homes

At the present time, when you have a health issue, your primary care provider may refer you to a lab, and so you go to the lab.  Then you go back to your doctor to discuss the test results.  But your doctor may look at the test results and decide to refer you to a specialist for a consult. So you go to the specialist, and then back to your doctor to discuss the specialist’s opinion. Sound familiar? Referral letters have been dictated and sent back and forth (often by fax still!).

With a patient medical home setup, you may be able to do all this in one place, saving considerable cost to the health care system, and time and trouble for you!  These PMHs in BC may be lead by a family doctor or a nurse practitioner. See this webpage of the General Practice Services Committee (a partnership of the primary care specialists of Doctors of BC, and the BC Government) discussing primary care reform in BC.

In BC, the patient medical home is being recognized as the foundation on which to build a streamlined and accessible service to patients. – from the GPSC website.

The following graphic sets out similar goals for a patient medical home as described in the College of Family Physicians of Canada’s Vision document and infographic above (adding two ‘networks’ of support to the ten goals):


Primary Care Home

A Primary Care Home in BC describes patient medical homes (full-service family practices) or networks of patient medical homes linked with health authority and community agency primary care services.  These services form the foundation of a coordinated system of primary and community care within the community. This team-based approach includes other health professionals working together with family doctors, forming networks of care. – see PMH and PCH webpage

In the PCH/PMH, care is provided in and/or coordinated across clinical settings including:

  • Ambulatory/office practice.
  • Hospital and long-term care institutions.
  • Emergency care settings.
  • Care in the home.

Across these clinical settings, communities will vary in how the comprehensive primary care services are organized and offered. This might look quite different in rural vs urban communities.

the-state-of-seniors-health-care-in-canada-september-2016Need for National Seniors Health Care Strategy

The Canadian Medical Association has released a report in September, 2016 on health care for seniors.

They say the report shows that many seniors are falling through cracks in terms of accessing care and services due to a lack of a national approach and strategy.

The CMA also says the report, The State of Seniors Health Care in Canada, demonstrates the need for a pan-Canadian strategy to address the health needs of Canada’s growing senior population.

The report contends that improvements in seniors care require the following elements:

  • increased focus on healthy aging;
  • improved integration of health and social services;
  • appropriate and timely care; and
  • support for family and other caregivers.

i-heart-public-health-creGet Involved!

This is an important juncture in the consideration of health care reform for older adults.

Have a look at the above, participate in any community forums, town hall meetings and other discussions on health care reform.

See the website and consider sending an email to your MP.

Talk to your representatives (MLA, MP) about what you think should be part of reforming Canada’s health care for the future, especially for older adults.