A courageous plan required for primary care reform

Posted on February 6, 2023 in Health Debates

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TheStar.com – Opinion/Contributors
Feb. 6, 2023.   By Danielle Martin, Edward Greenspon, Geogina Black

A foundational goal must be that primary care is accessible to every person in Canada, just as access to public school is available to every child.

Just-released data suggests that more than 6.5 million Canadian adults are without a primary care provider, whether family doctor or nurse practitioner. Imagine for a second if 1-in-6 Canadian families couldn’t enrol their children in their local public school. Outrageous. Unthinkable. Unacceptable.

Yes, it is. Health systems with strong primary care yield better health outcomes and improved health equity at a lower cost. Everyone deserves access to primary care, and everyone needs it, whether it’s management of COVID or long COVID, reconnection to services delayed or deferred over the last three years, or ongoing vaccinations; people without primary care can’t get access to the basics at this stage of the pandemic.

Canadians also require ongoing access to high-quality primary care for non-COVID reasons, from disease prevention and health promotion to early detection, well-person care and management of a broad range of acute and chronic physical and mental illness best addressed in a holistic, relationship-oriented system.

And so as First Ministers gather to address perhaps the gravest crisis in health care since the public system came into being, a foundational goal must be that primary care is accessible to every person in Canada, just as access to public school is available to every child.

A recent report by the PPF Council on People-Centred Health Reform, of which we are members, calls for guaranteed access to a primary health care team within a 30-minute drive of home or work. This is what Canadians expect. In a survey of more than 9,000 people just released by OurCare, a pan-Canadian project tapping into public desires for their health care system, 88 per cent of respondents said it’s important or very important that their primary care provider works close to their home.

Governments and policymakers do not own the health-care system; they are entrusted with its stewardship. And this week, they get to show what kind of stewards they are. Tolerance for (or indifference toward) endless discussion has run out. This is a critical shot at fixing what ails our precious single-payer system.

To us, two essential building blocks of the people-centred health reform we favour are timely access to primary care and the use of data. Data is a key tool to empower the users of the system and to support health care workers who need to care for people as they move through the system, from primary care office to hospital to home care and back.

Data is also the tool that can be aggregated and anonymized for uses beyond the level of the individual — a public asset that should be managed in the public interest. It needs to be marshalled in real time to drive better planning, research, and quality improvement across our multiple health fiefdoms. A truly people-centred system means that people have access to their own data, and that they can choose to share it with the providers in their team, safely.

These essentials have been talked about for years. It’s time for implementation, now.

These are the underpinnings for everything else the system does — from the range of care for everyone from children to seniors and the prevention of future surgical and other backlogs. Of course, the health system begins long before care is needed, with far-sighted policies to prevent illness.

The status quo is not holding.

Even more than money, we need courage. Courage to change the power balance.

Courage to redefine what our health care systems will cover. Courage to innovate with the humility to learn from failures. Courage to make transformative changes. That starts with the foundation of the health system, which is primary care.

Health care belongs to all of us and so reform must empower its true owners. The nation will be looking at their system’s stewards to rise to the occasion.

Dr. Danielle Martin is chair, Department of Family and Community Medicine, University of Toronto; Edward Greenspon is president and CEO, Public Policy Forum; Georgina Black is managing partner, Government & Health, Deloitte. All are members of the PPF Council for People-Centred Health Reform.


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