The Canada Health Act (CHA) establishes the primary objectives of Canadian health care policy – namely “to protect, promote and restore the physical and mental well-being of residents…and to facilitate reasonable access to health services without financial or other barriers" (Government of Canada, n.d.). Adopted in 1984, the Act provides for universal coverage of services deemed medically necessary as administered by physicians and/or in hospital settings (Flood & Thomas, 2016; Government of Canada, n.d.). However, an unclear and inconsistent definition of what constitutes medical necessity, combined with a lack of comprehensive consultation and little accountability over the past several decades has led to repeated calls for reform and modernization (Flood & Thomas, 2016).
As used in the CHA, medically necessary is a broad and subjective term meant to cover all bases and meet the needs of the general population. However, while seemingly comprehensive, the CHA’s medically necessary services fail to account for emerging and shifting health concerns and priorities, the health needs resulting from changing population demographics, and continually criticized exclusions, including funding of prescription drugs, dental care, mental health supports and accommodation in long-term care (Flood & Thomas, 2016).
As a Registered Social Worker and health professional, I have seen the health disparities created by an inability to receive services deemed not medically necessary. Low-income earners, aging and new Canadians, and those precariously employed, experience often insurmountable barriers to accessible and affordable care; opting instead to ignore health concerns, fail to fill necessary prescriptions or pursue necessary treatments and/or accommodation. What results is patient and familial stress, overall poorer health outcomes and the need for emergency intervention.
Conversely, I have seen what is possible when targeted programs work to break down these barriers. As an example, I have been fortunate to support an integrated health program which followed patients from hospitalization to home in response to the increased incidence of rehospitalization related to chronic disease. This program provided regularly scheduled follow-up (at intervals determined by research and best practice), access to health support and advice outside of scheduled (telephone) appointments, the provision of no-cost, in home therapies (initiated at point of hospital discharge) and access to medication coverage for the duration of program enrollment. The result: increased compliance, improved outcomes, emergency department diversion and a decrease in repeat hospitalization. The success of these and similar programs, speaks to the urgent need for CHA reform, namely a regular re-evaluation of medically necessary services, critical and ongoing evaluation of Canadian health priorities, and the consideration of inclusion of alternative services/treatments provided outside of hospitals and primary care offices (Flood & Thomas, 2016). But how do we get there?
In the field of social work, successful intervention is achieved through accountability and consultation. These same practices can and should be considered in modernization of the CHA, as well as in any/all health care reform, As Flood and Thomas (2016) explain, simply expanding the scope of services provided is not enough. Reform will and should require public awareness of proposed and established changes, as well as a transparent reporting of outcomes, with this information available for review in a digestible and accessible format (Flood & Thomas, 2016). Proposed amendments and inclusions should be reasonable, relevant, rooted in research, and reflect (enforced) consultation with experts, the general population, and members of traditionally vulnerable and underserved groups (Flood & Thomas, 2016). Additionally, a modernized CHA will demonstrate a commitment to frequent review and an ability to prioritize emerging needs and succession plan, rather than react urgently in the face of health crises. A modernized CHA might also consider the inclusion of, but not reliance on, services provided using e-health technologies (Flood & Thomas, 2016). Where appropriate, these services offer opportunity to improve access to consultation, care, and treatment. And, while not an option for all Canadians, preference for their use is increasing, and provides one more way to overcome financial, language, and location barriers.
Guided by the values and ethics of my profession, I will continue to advocate for this and other health care reform. I endeavour to work with and for Canadians to achieve a modern health system that is responsive to pre-existing concerns and changing health needs, and that prioritizes mental, emotional, and social well-being alongside physical health for the overall benefit of society.
References:
Flood, C. M. & Thomas, B. P. (2016). Modernizing the Canada Health Act. Ottawa Faculty of Law Working Paper No.
2017-08. Retrieved from https://ssrn.com/abstract=2907029
Government of Canada. (n.d.). Canada Health Act.
Ontario College of Social Workers and Social Service Workers (2008). Code of ethics and standards of practice
handbook (2nd ed.). https://www.ocswssw.org/ocswssw-resources/code-of-ethics-and-standards-of-practice/
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