Medicare has feet of clay new CMA head says

Jeffrey Turnbull says system failing to provide timely, fair and cost-efficient care

André Picard Public Health Reporter
Niagara Falls, Ont. — From Thursday's Globe and Mail
Published on Thursday, Aug. 26, 2010 1:58AM EDT
Last updated on Thursday, Aug. 26, 2010 8:37AM EDT

Canada’s medicare system is built on a foundation of lofty principles but, in practice, it is failing to deliver the timely, equitable and cost-efficient care to which patients are entitled, Canada’s top doctor says.

“To my fellow Canadians, I say on behalf of all doctors: You deserve better value. You deserve better service. You deserve better. And we will fight to ensure you get it,” Jeffrey Turnbull said Wednesday in his inaugural address to the Canadian Medical Association.

The new president of the CMA said with $183-billion spent on health care last year, resources are not lacking. And with thousands of dedicated health-care professionals, there is no lack of will to deliver quality health care.

The problem, Dr. Turnbull said, is the “glaring lack of execution” of policies and principles that results in the problems patients experience every day: long waits, shortages of beds, waste and lack of co-ordinated care.

“What we need most – even more than increased funding – is better and more effective systems of management and governance.”

Dr. Turnbull, who is chief of staff at The Ottawa Hospital, used his own hospital to illustrate the need for reform. On Wednesday morning, he revealed, occupancy in the emergency department was 105 per cent. Three patients were admitted to beds located in hallways. Meanwhile, there were 156 patients in the hospital who were supposed to be in long-term care facilities but who could not be moved for lack of space. And, since the beginning of the year, more than 400 surgeries have been cancelled because of staff shortages and conflicting priorities.

In addition to his hospital work, Dr. Turnbull is medical director of the Inner City Health Project, which provides care to Ottawa’s most destitute. Despite living downtown in the capital of one of the world’s richest countries, fewer than one-third of those patients will reach the average life expectancy of 80. Virtually all of them suffer from severe mental health and addiction problems, 80 per cent are infected with hepatitis C, and more than the one-third have HIV-AIDS.

“Canadians value their health care. They cherish the idea that services are provided without regard to income or means – the idea that quality health care is the birthright of all who live here,” Dr. Turnbull said.

“But you can’t be cured by an idea. You can’t be made healthy by a theory. The system needs to work in practice. And, right now, today, in too many places across Canada, health care isn’t working nearly well enough.”

Dr. Turnbull vowed to push for reform that will make the medicare system better in the short-term and sustainable in the long-term.

Earlier this month, the CMA released a report entitled “Health Care Transformation in Canada: Change that Works, Care that Lasts.”

In that document, the group argues that the current health system cannot meet future needs because of the aging population, technological changes and ever-more-demanding consumers. It calls for significant changes, including a universal prescription drug plan, a charter that enshrines the rights of patients, an independent body that can monitor whether health dollars are being spent efficiently, and monetary incentives for doctors and hospitals to treat more patients.

Dr. Turnbull vowed to lobby for those changes and others and said the key to getting politicians to act was engaging the public in a national dialogue.

The CMA’s general council meeting, which wrapped up Wednesday, was notable for the collegial tone of debate. In the past the group has been torn by fierce differences on the relative roles of publicly funded insurance and private for-profit care.

“I don’t think that discussion has died,” Dr. Turnbull said. “But we’ve decided to discuss the fundamentals first.”

Canadians need to clearly define their expectations and they can figure out later how to pay for the system later, he said.

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