Sunday, October 19, 2008

The Mission of a Medical System

I made a comment on Andre Picard's article 'Taking on Our Sacred Cow' posted on Oct. 16, 2008. I agree with the thesis of the article, that even though the economy overshadowed healthcare as an election issue the future of medicare will need to be discussed in the near future as it's one of government's major costs at all levels in Canada.

Before we start debating medicare's future I want to suggest that we talk about what the mission of medicare is. I guess we can start my repeating the tenets of the Canada Health Act:

1 Public administration
2 Comprehensiveness
3 Universality
4 Portability
5 Accessibility

That already complicates things though. At a very basic level we need a simple mission within healthcare policy and delivery. We need a mission that applies as well in Japan and Ghana as it does in the U.S and Canada.

What about: 'Decrease the burden of pathology'? That would include trauma and acute illness as well as chronic conditions. I think that it would also force healthcare and prevention to be considered in the same discussion. Can we combine that many areas, currently operating in isolation, into a new system though?

Even more encompassing would be: 'Making people better'. This might be too vague though. A mission has to communicate goals clearly to everyone who would be active in achieving them.

Here's a final try: 'The right intervention at the right time'. We should be intervening to improve the non-healthcare social determinants of health immediately. This statement acknowledges that. We should also be ensuring that there is enough capacity to deal with life-threatening conditions and trauma while managing wait times for elective procedures.

These are off-the-cuff mission statements I came up with on a Sunday afternoon. Let's get this discussion going with some ideas from the audience. Tell me what you think of my missions and post your own!


geovani said...

In practice, this almost never occurs, and the annual health expenditure data published by the(CIHI) confirm that Canadian dental services are almost entirely financed privately. Lobbying by other providers, including nurses, led the act to speak of 'practitioners' rather than physicians; physician services had to be covered, but provinces were allowed, but not required, to define other health professions as qualifying under the Act. To date, this provision has been used only occasionally; for example, some provinces have added Midwifery, which means that their services are also fully publicly paid for.

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Indonesia said...

Your post about how the mission of a healthcare system should encompass non-healthcare related social determinants of health reminds me of a podcast I listened to recently. The podcast was an interview of Dr. Vera Cordeiro Rio, social entrepreneur and founder of Renascer. In her 10 years as a pediatrician in Brazil, Dr. Cordeiro Rio began to see a pattern of the same children being hospitalized over and over again. She identified many of the root causes of these visits as being poverty-related, and started an organization that tries to address healthcare in a holistic way by first addressing the social issues that are key to good health, like housing and sanitation. It's an interesting interview for anyone who's interested in these issues. A description as well as the podcast itself can be found at the following link: