Canada’s Health Care System – A two tiered health care system? (Part Two)

Sep 5, 2011 by

A two tiered Canadian health care system?

Have I even sold myself on the idea yet? Not entirely, but that is because for the most part I haven’t looked closely at how it would be managed. How would we keep the system as equitable as most Canadians would expect?

Canadians have the expectation that health care is provided by the Government and that there are no additional costs beyond medications, etc.. If you simply can’t afford anything then everything will be provided by the Government, including prescription drugs, canes, crutches, wheel chairs, etc..

The one expectation that I think is the most important is that the same level of health care is available for everyone, whether you own a Porsche dealership, or you wash the cars at that dealership. If you need a liver transplant, things such as lifestyle, age, health, chances of recovery, threat to life, etc.,  are all used in the triage-based selection process, not the money you have in the bank.

We brought this key idea up in part one of this article and I think we can feel confident in saying that this is in fact the most important criteria of all to Canadians. We will continue using this as the premise for Part Two.

If in fact Canadian health care is completely socialized, each individual’s long-term behaviour regarding issues such as weight, level of fitness, nutrition, oral hygiene and general lifestyle choices all end up directly affecting the health care system. The effect they have, whether positive or negative, is largely in the hands of the said beneficiary of the system. Correct? Let’s just look at three places where an individual’s personal choices can affect the fitness of the health care system itself: nutrition, oral health care, and exercise.

I’m betting at least one of my two readers was expecting me to say cigarettes and/or alcohol and/or illegal drugs. I propose that these things are actually insignificant in terms of negative effect when compared to the long-term consequences of poor nutrition, poor dental hygiene, and lack of exercise. In a further article we may examine these last three in further detail for their own sakes. For the purposes of this article I wanted to bring up the potential, as diplomatically as possible, that there are at least two or three things within the control of an individual citizen that would improve the quality of their life, and reduce costs to the medical system as a by-product.

In the first article we briefly mentioned some of the improvements we would like to see in terms of our relationship with our primary health care provider.  The first was:

 “Doctors should be required during their training to learn some “common sense” preventative practices. These ‘practices’ should be required by law to be discussed with all patients who have recurring illnesses that may be statistically tied to diet and exercise. In other words, a physical that not only tests how well you are clinically, but also tests the patient on what they are doing via healthy habits to regain one’s health or to simply stay healthy.”

Now I would like to illustrate the above with a situation I was personally involved in.  My mother, who at the onset of her  trouble was 62 years old, was losing a drastic amount of weight, had continuous diarrhea, and was sleeping constantly. Had she been examined by only one doctor, then what was happening as far as her care was concerned, while still inexcusable, would have been at least easier to understand.

By the time I was told what was going on,  she was down to 44.5 kg (98 lbs) and being somewhat dramatic and macabre she was phoning me to tell me, “Rodney, I’m not long for this world!”

Not something a son likes to hear from his mother. And so she proceeded to tell me what had been happening to her for the past few months. At this point she had been seen by 3 more specialists, had a barium enema, internal X-ray (swallowing barium sulphate), sonograms, blood tests – countless, urine samples – countless. Yet still no answers – and she continued to lose weight and sleep too much.

So where does this all end up leading? How about one simple question: “What do you eat on a daily basis, what would a normal week of meals be?” After asking my mother this question myself, I then asked her to immediately stop eating all dairy (including cheeses, yogurt, etc.), all wheat products, eggs, and chocolate. In 24 hours the constant mental fogginess and fatigue lifted, within 72 hours the diarrhea that had been plaguing her for months cleared up, and within a week she started to gain weight again.

Here is a simple situation where a person went through months of unnecessary grief and discomfort for no good reason at all. My mother’s case was sent from her family doctor  to one specialist after another.  Why did several health care professionals all fail to see an obvious food intolerance? A simple, practical, and very common “elimination diet” should have been one of the very first things suggested, and obviously this should have happened at the level of her G.P.. This situation cost the medical system thousands of dollars in diagnostic tests – easily twenty thousand dollars or more, the time and pay of multiple specialists and diagnostic support staff, and the list goes on.

The worst of this all of course is that my mother could actually have died, or at the very least, ended up for a prolonged stay in the hospital – hoping someone there would finally figure it out.

The point of all of this is to illustrate that our first improvement mentioned above would have avoided this situation from the onset.  

Our medical system might want to consider setting up some publicly funded nutritional outpatient services at hospitals and community medical centers in major cities.  These nutritional service centers would be “mandatory” as part of a person’s wellness program.

Because Canada is so widespread, this “mandatory” system should be developed such that appointments with counsellors can be conducted by phone or over the internet,  and courses can be attended over the internet. This would make such a system easily affordable, easily accessible, and easily maintainable. I believe the benefits could be proven with existing data sets, providing they are publicly available.

Our medical system should put a great deal of responsibility on front-line medical support personnel and increasingly on the patients themselves. This responsibility could be stated in such a way: “If you are to receive publicly funded health care from the cradle to the grave, then you will required by law to not only pay your monthly dues (based on income) but to follow up in such ways as ….”

One possible way to “constantly elevate” a patient’s responsibility could be by the frequency at which they require the services of a health care provider. If they reach some arbitrary “use” threshold  they should be required to attend a nutrition course, etc..  Obviously if a person had a diagnosed terminal illness, etc., they would be exempt, if they wished, from such mandatory programs.

In a case where a person has not received any medical services for an arbitrary period of time – for the purposes of this discussion,  a period of 18-24 months – their medical record would indicate that they are due for a nutritional\fitness assessment. Moreover, I believe it would be prudent and cost-effective to assess seniors for all of the above criteria at least once a year from ages 65 and up.

In this article we have looked at quite a bit of subject matter and still haven’t even glazed the surface of the first colossal question, “Should Canada have a two tiered medical system?” 

We brought up in this article how nutrition, oral hygiene, and exercise are all issues that might be looked at in a health care system that was less reactive and more proactive, in terms of having education programs either put in place or expanded where required – education for health care professionals as well as for the patients, the end beneficiaries of this enormous system.

We have yet to even broach the subject of how oral hygiene and exercise might be integrated into the greater health system without being unduly difficult to administer or causing prohibitive costs. It should be easily provable, with existing data sets, amortized over significant periods of time, that the additional costs of proactive education are minimal when compared to the potential negative financial and social costs of illness and loss of life over a longer study period.

I propose we would see the benefits of these programs directly in under a decade. The full enormous benefits of these programs would start to be seen in 50 years as a new generation is brought up with this as part of their culture. Their lives will have a lesser impact on the overall health of the system itself as they themselves will be a generation of fitter people.

In the next article we will take a closer look at nutrition, oral health care, and physical exercise, and how these should not be overlooked in any health care system, and especially in a socialized health care system. We will then be one step closer to being able to look at the larger issues.

We will also need to address this question as well;

“is our basic premise of equal health care to all Canadians regardless of economic standing in fact real?”

Until next time.