Health

Pushing home care

Ottawa shifts its focus away from hospitals

March 9 1998
Health

Pushing home care

Ottawa shifts its focus away from hospitals

March 9 1998

Pushing home care

Health

Ottawa shifts its focus away from hospitals

As federal minister of health since last June, Allan Rock says he will keep up the pressure on his cabinet colleagues to properly fund health-care initiatives. But he also attributes some basic problems in the system to organizational rather than financial shortcomings. In a conversation last week with Maclean’s Board of Editors, Rock outlined how he sees improvements in home-care provisions as a key to bolstering the system.

Maclean’s: Is the health-care system in critical condition?

Rock: I think we’re in a period of transition in health care in Canada.

We’re going from the quill pen, hospital-based days through to a modern integrated health-care system of the future, which draws upon information technology for efficiency.

Care takes place not just in the doctor’s office or in the hospitals but also in the community. In future it will be recognized that doctors are no longer compartmentalized, standing apart from all other caregivers, but are members of a team in which the appropriate person—whether it’s a therapist, a case worker, a nurse practitioner or a physician—is given the task that arises.

Maclean’s: Do you think Canada can avoid a two-tiered health system?

Rock: I absolutely do. And I think the way we meet those who would have a private parallel system is to ensure there’s never a market for it. We’re very proud of our public health-care system. But we have to remember that it’s not something that we can take for granted. Broad public support for the single-tier public health system isn’t automatic; it will remain only as long as people can be confident they’ll get the highest possible quality of care as and when it’s needed. And I think that’s part of a bargain governments have with the Canadian people. If we don’t keep our part of the bargain we’re jeopardizing support for medicare.

Maclean’s: And are the federal and provincial governments keeping their side of the bargain?

Rock: I think both federal and provincial governments can do better. If you look at the pace of restructuring in some parts of the country, it has gone ahead quickly with hospital closings, for example. But govern-

ments haven’t followed up with the reinvestment in community and home care where it’s needed. Health care for people used to mean hospitals and doctors. But hospital stays are shorter now because of improved medical technology. It’s possible to have abdominal surgery and come out the next day, whereas it used to be a twoor three-week

stay. But when you come out you often need someone to change your dressing, to check your condition, to look after you in the home, at least for the period of your recuperation. The availability and quality of that care in Canada at the moment is uncertain. Maclean’s: The provinces who are responsible for delivering those services say they can’t afford them.

Rock: Well, it’s often said that these problems arise because of money. But maybe the better way of looking at it is: what kind of system do we want? And this gets us into the area of quality and standards. But, that being said, I have no doubt that we’re going to have to modernize the system through home and community care. The Prime Minister has said that 50 per cent of any future surplus will be devoted towards reinvesting in social programs. And I’ll certainly be an advocate for health being among the first priorities in future spending. I would not deny

that federal cuts have had an effect; they have. But we’ve turned the corner, the era of cuts is over, we’ve stabilized cash transfers [to the provinces] and we’re going to build from there.

Maclean’s: What levers can Ottawa operate to encourage the provinces to improve home-care provisions?

Rock: Many provinces already have home care of one description or another, and a handful lead the way. As to what influence Ottawa would have over the adoption of a standard approach to home and community care, I hope that is going to be worked out over the next 12 to 18 months. We will be developing some consensus about the importance of home and community care and how it might be furnished in accordance with standard definitions and common approaches. It has to be woven into the fabric of health insurance, just as physicians and hospital services are now. We also need an approach towards the quality of care. I see, for example, standardized training for homecare workers as an essential part of this. At the moment, that’s not in place in many parts of this country. Maclean’s: When you talk of home care, what do you envision?

Rock: Home care could be anything from maintaining the house for an elderly person who is not able to do it, to someone who might drop in with meals, or a nurse practitioner coming by to take vital signs, right through to looking after someone who is recovering from acute care. And I should stress that I don’t think home care can be looked at in isolation—it’s tied into everything else. I can’t imagine solving the home-care riddle without also resolving some of the pharmacare anomalies. You know if you’re in the hospital in some parts of this country and you’re taking chemotherapy, for example, you get the drug for nothing because it’s covered by medicare. But if you’d rather be home during the course of your treatment, you have to pay, sometimes $2,000 per treatment. So I think all of these initiatives are connected.

Maclean’s: How realistic is it to expect provincial co-operation on widespread changes to the health-care system?

Rock: In an area like home care I’m very optimistic. First, I think there’s a broad and growing perception that it is needed. Second, many of the provinces have already started down that road. Third, acting in a coordinated fashion will give us an opportunity to make it a standard approach across the country. Fourth, there is the prospect of federal help in financing the plan. Finally, I think the provinces also acknowledge that with a properly developed home-care system they can save money in other parts of the health-care system. □