Medicare needs to get better, not bigger

TheStar.com – Opinion
Published On Wed Apr 28 2010.  By Carol Goar, Editorial Board

Dr. Arlene Bierman had a few illusions about the Canadian health-care system when she arrived in Toronto.

She moved here seven years ago to become the first chair of the Ontario Women’s Health Council. At the time, she was working at the U.S. Agency for Healthcare Research and Quality in Washington, investigating the gaps in her country’s medical health-care system. Trained in internal medicine and geriatrics, she had become a top medical researcher.

But Bierman, a New Yorker with a strong sense of social justice, believed every American deserved access to affordable health care. And with George W. Bush firmly entrenched in the White House, there was little hope of progress toward universal medical coverage.

So when she was invited to continue her research at the newly formed Ontario Women’s Health Council, working as a senior medical scientist at St. Michael’s Hospital and a professor of health policy at the University of Toronto, she joined the brain drain of American professionals, academics and scientists to Canada.

She expected to find the publicly financed health-care system in her new home offered equitable treatment to all Canadians, regardless of income, employment status, race or background. But she quickly discovered hidden barriers and wide disparities in morbidity rates between rich and poor; men and women; young and old; urban and rural patients and people of different ethnicities. “I was quite surprised,” Bierman recalled. “I came here thinking Canada would be much better.”

She believes it can be better. But it will require policy-makers, health-care providers, community workers and the public to work together to tackle the inequities that are driving up the cost — and eroding the quality — of health care.

“Everybody knows poor people are sicker,” Bierman says. “That’s not the point. The point is that we can do more about it.

To convince evidence-driven decision-makers that medicare is failing many Ontarians, she and a 60-member team of researchers are compiling the most comprehensive report on women’s health ever done in this province.

The first volume (http://www.powerstudy.ca/) is already out. It examines cancer, cardiovascular disease, depression and how the burden of illness is distributed. The second volume, to be released in chapters over the summer and fall, looks at diabetes, HIV/AIDS, reproductive health and musculoskeletal disorders (such as arthritis and osteoporosis).

Most of the statistics in the report have been published in hospital studies and medical journals. But no one has pulled them all together, highlighted common themes, checked to see if the findings match the experiences and perceptions of patients, and shown governments, regional health authorities, hospitals and medical practitioners steps they can take now and over the longer-term to improve the care they provide and make the system more sustainable.

“I’ve been surprised at how useful this information is,” Bierman says. “Medical practitioners say, ‘We know these things, but now we have actionable data. We can set priorities and develop interventions.’ ”

Doctors aren’t the primary impediment to reform, she maintains. “They get it now. There is a lot of interest in making it better for patients.”

The government is beginning to adjust its thinking too, Bierman says. She points to Deb Matthews’s speech to the Canadian Club on Apr. 7 as an encouraging sign. The health minister said providing better care — not just more treatment — is her objective.

So what are the obstacles? The health-care system is still rigidly compartmentalized and riven by competing interests. Politicians see little electoral advantage in targeting resources at disadvantaged groups. Doctors don’t regard poverty or hunger as medical problems. And taxpayers are fiercely protective of what they have.

Bierman has seen where this scenario leads. She wants to help Ontarians develop and implement a better one.

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