The 13 pieces of a fragmented healthcare system.

In Editorial, Opinion by Edmund KwokLeave a Comment

As Canadians we pride ourselves on having one of the best national healthcare system in the world. That is however not technically correct – instead, we have a jigsaw system that’s cut up into very distinct and different pieces.

The Canada Health Act supposedly ensures that all citizens have equal access to quality healthcare, regardless of where you live. Working in a tertiary care center situated right on the border between two of Canada’s largest provinces, we are witness to daily reminders of the desperate gap between that dream, and the reality of individual provincially administered healthcare.

Just the other day, I had to explain to yet another patient why she waited in the ER for 5 hours … for nothing. This patient presented with a scenario that seems to be becoming disturbingly more common: access to primary health care is much more difficult in her home province, and referrals for specialist care is even more dismal. In addition, her physical place of residence is much closer to our tertiary care center (a stone’s throw across the provincial border). After many months of trying to see her primary care physician, and many more months of waiting for a referral that never materialized, she finally came to our ER seeking more timely access to care that is closer to her home.

Except I couldn’t provide her with the necessary care she deserved.

Her home province has been so inconsistent with reimbursement of fees to physicians who take on its patients, that many clinics and specialists in our province are refusing to take referrals from Canadians residing in our neighboring province. Patients like this one end up waiting longer and traveling greater distances to access the same care as their fellow Canadians across the border.

It is almost like we live in 13 completely different countries when it comes to healthcare – in reality, we probably do.

And with the federal government’s recent decision to stay “hands-off” on the delivery of healthcare, we are inching closer to solidifying that reality. The inequality across the country is apparent in all facets of care, from access to specialists to drug coverage such as chemotherapy treatments for various malignancies.

I applaud efforts such as the recent conference of premiers in Halifax, which are born out of frustration from this very core problem – however, much like this commentary, I reserve a healthy dose of skepticism on their ability to actually address the issue without greater federal leadership and commitment.

In the meantime, we can only keep doing the best we can within the constraints of a fragmented healthcare system, aptly described as not being unified, but rather a “nation of pilot projects” fumbling around in varying directions.

My guess is that as patients, you and I will suffer most as a consequence.

Edmund Kwok

Edmund Kwok

Emergency Medicine. Quality Improvement. Patient Safety. Change Management. Healthcare Administration.

Frontdoor 2 Healthcare

Frontdoor2Healthcare, founded by Dr. Edmund Kwok in 2012, provides editorial and commentary on issues affecting Canadian healthcare from the emergency department’s “front door” perspective. Frontdoor posts allow for open sharing of the diverse opinions and perspectives of emergency physicians from across the country.

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