14 Apr April 14/10 – Opinion Editorial: Progressive Agenda Vital

Wednesday, 14 April 2010

Progressive agenda on health care vital

By KYLE BUOTT
Wed. Apr 14 – 4:53 AM

The House of Assembly went back into session on March 25 and the Nova Scotia Citizens’ Health Care Network wants to put forward several progressive reforms that will improve and protect our public health care system. We encourage all MLAs and political parties to give serious consideration to these policies. It is high-time that we had action on health care in this province.

First and foremost, we need to enshrine the principles of the Canada Health Act in provincial legislation. These five principles — public administration, comprehensiveness, universality, portability and accessibility — are the cornerstone of our health care system and putting them into legislation, as Ontario and B.C. have done, would strengthen the health care system against for-profit privatization.

Then it is time to tackle some of the inefficiencies in our health care system, including fee-for-service payments for physicians. Nova Scotia is already a national leader in promoting alternative payment plans (APP) for physicians; indeed, more than 30 per cent of our physicians are already on an APP. Getting physicians off fee-for-service helps stabilize physicians’ incomes and encourages them to spend more time with patients, as it removes the financial incentive to rush patients through.

Additionally, it creates an incentive for physicians to hire allied health care workers so that they can have more patients registered at their clinics. This would also help address the shortage of family physicians in the province and improve Nova Scotians’ access to primary care.

We also need to move towards integrating physicians with nurse practitioners, social workers and other health care workers to provide a full scope of services to patients. The provincial government should provide funding for community health centres, which are democratically run by an elected board and deal specifically with the health care issues in their communities. The best example of such a centre is the North End Community Health Centre in Halifax. Again, increasing the number and capacity of these centres will improve access to primary care and help reduce wait times.

Then we need to tackle for-profit privatization, which is slowly creeping into acute care and has already established itself at dangerous levels in long-term care. The government should cancel the contracts with Scotia Surgery for orthopedic surgeries and McKesson Canada for the tele-health service, and bring these services under public administration.

In long-term care, the government should put an immediate moratorium on granting new contracts to for-profit long-term-care homes. The research shows that for-profit long-term-care homes have higher death rates, lower quality food, and lower levels of cleanliness. Also, having worked closely with long-term care workers, we have reason to believe that some for-profit, long-term-care homes are not meeting Nova Scotia’s care guarantee of 3.5 hours, which means patients are receiving less direct care than they are entitled to receive.

To improve long-term care, we need to create a capital investment fund for public and not-for-profit homes to allow them to make improvements to existing facilities. We should also create a system of family councils in long-term-care homes so that seniors and their families are able to voice concerns through a more formal channel.

Another reality we need to contend with is that Nova Scotia has too many layers of bureaucracy in health care. We currently have nine district health authorities, plus a separate structure for the IWK, all for a population of less than one million. The City of Toronto services a population of over one million with just one health authority.

We need a comprehensive review of the governance structure of our health care system with a goal to improve efficiency, reduce bureaucracy, and increase local control and decision-making. Looking back on the 1994 report, the Nova Scotia Blueprint on Health System Reform, would be a good first step.

These areas are just a start, but they represent a series of progressive policy options that would help transform Nova Scotia’s public health care system to face the challenges of the 21st century. By reaffirming the values laid down when medicare was created — that everyone should be entitled to care, regardless of their ability to pay — we can continue creating a fair and just society that helps protect our families and builds communities.

Kyle Buott is provincial co-ordinator, Nova Scotia Citizens’ Health Care Network.