A new Canadian Medical Association (CMA) report on health-care transformation was met with a mix of optimism and concern by the Canadian Nurses Association (CNA).
"CMA is to be commended for contributing to the debate on health system transformation" said CNA president Judith Shamian. "We are pleased that many of the recommendations align with reforms that registered nurses have been proposing for years, including enhanced patient access to home and long-term care, and a more prominent focus on broad determinants of health. Canada's nurses invite an open and frank discussion on how to best go about implementing these reforms."
CNA believes that Canada's health system needs to be advanced and overhauled so its population can access a full range of services without compromising their financial well-being. At the same time, we all need to work on advancing the system within a cost-effective framework. While CNA agrees that health system transformation is long overdue, it is not clear how CMA's policy recommendations will, in fact, meet the legitimate health-care needs of Canadians while being affordable to the public purse.
"We have grave concerns about some of the recommendations in this report," Shamian said, "first and foremost being the call to re-open the Canada Health Act."
CNA believes it is necessary to have an amendment to the Act so consistent services can be offered to Canadians in areas that are not currently covered, such as rehabilitation services, preventive care, home care and more. Opening up the Canada Health Act is precarious and puts the spirit of the Act at risk. CMA's report proposes significant changes to the Act, which include an array of funding options and performance incentives that open the door to private, for-profit care services that would compete directly with the public system.
"In its report, CMA calls for 'political courage and leadership' as well as flexibility from within the health-care professions," noted CNA's chief executive officer Rachel Bard. She added, "We need to be asking what the physician community is prepared to change as its contribution to a transformed health-care system. We cannot build a transformed, patient-centered health system based on a physician-focused delivery model." CNA notes that even in areas it could support, such as electronic health records for all Canadians, the report takes on a physician-focused "medical record" tone, and calls for the bulk of investments to be directed to physician use rather than health teams.
According to CNA, many other health-care professionals - including nurse practitioners, physiotherapists and psychologists - serve as cost-effective entry points into the health-care system. "For example, we know that most Canadians are in favour of an expanded role for nurse practitioners," Shamian said, with three in four saying they would be comfortable seeing a nurse practitioner instead of their family doctor. A 2009 Canadian Press Harris-Decima survey found that 88 per cent of respondents would be comfortable being treated by a nurse practitioner at a walk-in clinic. And studies show that the addition of a registered nurse to a family practice has a tremendous positive effect on the number of patients that can be served.
Employed widely, these kinds of cost-effective strategies will ease the physician bottleneck that is slowing down timely access to health care.
"We are eager to see health-care reform back on the political agenda," said Shamian. But for CNA, health reform includes broad policy around housing, healthy aging, income support, and thinking about the way resources are used across the system rather than assuming more must always be added.
According to Shamian, nurses propose "future-focused, cost-effective solutions to ensure that the broad health needs of all Canadians really can be met in sustainable ways within the public health-care system. CNA will create new opportunities to engage health professionals, governments and decision-makers in meaningful dialogues about system transformation."