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Revamping the Canadian healthcare system

U of T professor Danielle Martin proposes six ways to improve efficiency and quality
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When it comes to public health care, more resources will not necessarily result in improved service. According to Danielle Martin, a leader in the movement to improve Canada’s healthcare system, Canada should focus efforts on reorganizing resources, not on finding more.

Martin, an Assistant Professor in the Department of Family and Community Medicine at the University of Toronto and the Vice-President of Medical Affairs at Toronto’s Women’s College Hospital, has been advocating for the preservation and improvement of Canada’s health care system for over a decade.

In her recent book Better Now: Six Big Ideas to Improve Health Care for All Canadians, Martin proposes ways to enhance our current health care system’s efficiency and quality.

First, Martin suggests a return to strong relationships between primary health care providers and individual Canadians. In an interview with CBC News, Martin stressed that this relationship will form a safety net for Canadians as they navigate the health care system.

Second, she recommends that the country include prescription drug coverage under Medicare. In a video published on U of T Medicine’s YouTube channel, Martin notes that Canadians pay unusually high prices for generic medications. This forces many Canadians to skip or entirely forgo necessary medications in favour of meeting fixed expenses such as housing and transportation.

Third, Martin explains that our health care system should reduce unnecessary tests and interventions. In the same U of T Medicine video, Martin draws attention to Choosing Wisely Canada, a campaign encouraging physicians and patients to ask the right questions in order to reduce unnecessary tests, treatments, and procedures.

Fourth, Martin proposes that we reorganize health care delivery to reduce wait times and improve quality. As discussed in her interview with CBC News, Martin suggests the adoption of a bank system in which there is one central line for health care and patients are seen by the next available, qualified provider.

Fifth, she believes our current system would benefit from a basic income guarantee. Income is the primary social determinant of an individual’s health, therefore meeting the basic income needs of Canadians who fall below the poverty line has the potential to make the greatest difference in the health of Canadians, she argues.

Martin’s sixth and final proposal is to scale up solutions which have already been successful locally. Martin cites a Vancouver project in which the collaboration of family physicians and orthopaedic surgeons reduced wait times for hip and knee replacements from eighteen to three months.

If we were to scale up these kinds of innovations to a national level, the impact could be substantial, she says.

According to Martin, the role of public discussion in achieving these proposed changes is “the most critical thing… The kind and quality of change we need most will only come about if it is the consequence of popular consensus and widespread public engagement.”

Productive public discussion includes everything from “the ways that you interact with your own healthcare team as a patient to the questions you ask the canvasser on your doorstep,” she says. “[Each discussion should lead] us to not just think differently but act differently, and demand different actions of the institutions around us.”

In addition to public discussion, Martin emphasizes the importance of political courage. When asked about the roadblocks faced by political leadership in promoting these suggested reforms, Martin says, “Change is challenging and this is true especially when different interests are competing — healthcare isn’t the sole priority of any government and the status quo is a powerful state.”

Within current discourses on healthcare, Canadians “often hear the argument that change is too costly.” At the same time, we hear “rhetoric about the system being unsustainable.” Martin believes neither is true and that “the only way to overcome opposition to positive change is by starting the debate from a place of strength — with the evidence in hand.”

When asked about the potential of political courage in the upcoming federal election in 2019, Martin says that, while travelling across Canada on her book tour, she has had “even more reason to believe that we have the courage to push for change… A lot of people are very attuned to the things we need to do to make healthcare better for everyone, including our politicians.”

She adds, “What we need to do is set the stage for that courage to manifest itself in the platform commitments not only of federal parties in 2019, but in provincial elections across the country until then. Concerns about fiscal constraints are always dominant, which is why it is critical that we talk about how to make improvements to the care Canadians receive, without spending a lot more money.”

Despite the challenges associated with change, Martin remains optimistic and holds that “the important thing is that we never stop believing that our voices matter. Healthcare is one of the most important social programs in the country and we have so much to gain from making it better and so much to lose if we let roadblocks discourage us.”