As medicare turns 50, let’s see the full vision implemented
For AOHC, “medicare” is not just the inner workings of our health system. For us, medicare is an inspiring aspiration enshrined in Canada’s Health Act:
… to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial barriers and other barriers.
Financial barriers were addressed in medicare’s first stage – a publicly funded health insurance system designed to cover costs for doctors and hospitals. The second stage that Tommy Douglas and medicare’s other founders envisioned was intended to address the other barriers standing in the way of improved health and well-being – the root causes of poor health and out-of-date delivery of care.
In the final years of his life, Douglas reminded Canadians about the importance of completing this second stage. “Let’s not forget,” he said, “the ultimate goal of medicare is to keep people well.”
This full vision of medicare underlies AOHC’s own vision of the best possible health and well-being for everyone living in Ontario.
So even as we celebrate the 50th anniversary of the implementation of medicare, we say it’s time to move forward with real solutions that work for all Ontarians. The good news: scores of these solutions are already underway in our public not-for-profit health care system. But they are not happening widely enough. Our challenge: to break down barriers so we can start spreading these solutions right across the province enabling all Ontarians to enjoy their benefits.
Some progress has been made. For instance, this winter AOHC applauded Ontario's new action plan for health care, and especially its commitment to make primary care a cornerstone of health system transformation.
AOHC’s executive director Adrianna Tetley committed the province’s 73 community health centres, 10 Aboriginal health access centres, 15 community-governed family health teams and 4 community-governed nurse practitioner-led clinics to meet the challenge Health and Long-term Care Minister Deb Matthews laid out in her action plan.
She could have been echoing the founders of medicare themselves as she said: "Now is the time for primary health care to live up to its full potential, focusing on keeping people well and not just treating them when they are sick. We also need to ensure that individuals and their families receive coordinated care as they navigate through different parts of the health care system."
This is a very possible vision. It puts people in the centre of the care and services they need, and looks at the person – and the health and social services systems – as a whole.
To achieve this, Ontario must move beyond a narrow medical approach that constrains health promotion. Needs-based planning must guide the way. Let’s name the regions have the greatest need for more primary health care services. And where are needs most complex? These are the places where doctors and nurses should be working in close collaboration with the other parts of the health and social service system.
This kind of planning and concern that all parts of the system are integrated are hallmarks of people- and community-centred care.
Features of people-centred care include:
- Comprehensive primary health care planning designed to meet the various needs of diverse populations;
- A more complete set of services and programs that focus on the many different determinants of health at work within families and communities;
- To improve the health of populations with complex needs, primary care services delivered in partnership with community support, mental health and addictions, social services such as immigrant services and housing, and education;
- Equitable, timely and continuous care that is comprehensive, evidence-informed and culturally safe;
- Every Ontarian having access to interprofessional teams equipped and enabled to work to their full scope of practice.
When decision makers commit to policy changes that encourage increased innovation in our health system, we can complete the second stage of medicare. And when we complete the second stage of medicare, Ontarians will be healthier, and our health care system will be more sustainable – now and for generations to come.
Medicare pioneer Tommy Douglas
- Tommy Douglas on the second stage of medicare (YouTube)
- Report on Second Stage of Medicare, 2007 Conference
- Medicare at 50 blog (focus on Saskatchewan, where medicare first implemented)
- The role of CHCs in strengthening medicare
- Medicare is a part of us (Globe & Mail)