This is the fifth of six editorials we will publish ahead of the provincial election on May 9. The first four dealt with government finances, housing, proposals for managing the economy, and environmental protection. Today鈥檚 looks at health care.
It seems to be a truth about this essential public service that it is rarely loved or praised, at least in the abstract. Many patients tell heart-warming stories about the care they received. Yet there is a general sense that the system is under constant pressure, and at times approaching the breaking point.
Yes, our hospitals are highly effective at dealing with the most pressing cases. Patients who require treatment for a heart attack or cancer get first-class care. This is the tip of the medical pyramid.
But lower on the urgency scale, the story is different. Many British Columbians can鈥檛 find a family physician. Mental-health services are wholly inadequate, and home care is far too scarce. It is here, at the base of the pyramid, that public dissatisfaction is strongest.
One reason is that, despite promises to devote more effort to community-based care, hospitals continue to dominate the medical landscape. There is a notable preference for shining new facilities at the expense of less glamorous services.
Island Health is building a pair of new hospitals, in Campbell River and Comox. Design experts believe this makes no sense. They said repeatedly the correct answer was to build just one facility, midway between the two communities.
But Island Health gave in to pressure from local politicians and made the popular rather than the pragmatic choice.
This month, the Co-op Health Centre in James Bay announced it lost money in 2016. The co-op couldn鈥檛 find enough family physicians to work at its clinic, and came up $11,333 short.
So here is an exemplary model of integrated care, in trouble for want of a pittance. Meanwhile, Island Health wasted tens of millions on a hospital we didn鈥檛 need.
It wasn鈥檛 supposed to be this way. In 1991, the sa国际传媒 Royal Commission on Health Care and Costs recommended moving health care closer to home.
The idea was to divert resources from hospitals to community-based facilities such as the James Bay clinic, place an emphasis on preventive services, and help the elderly remain in their homes instead of institutionalizing them.
But we鈥檙e further than ever from that vision. Part of the problem lies in a growing reluctance among physicians to enter general practice. A variety of causes are cited.
Family medicine is emotionally draining. Many of the patients are elderly, with chronic ailments not easily cured. That might be why more medical-school graduates go into pediatrics than geriatrics, despite the aging of our population.
As well, GPs must shoulder the administrative costs and burdens of running an office. Far easier to work in a hospital, where those matters are taken care of by the health authority.
And that hints at a second cause. For all their complexity, hospitals and long-term care facilities are relatively easy to run. Everything is under one roof.
Dispersed as it is, community care is far harder to manage. The linkages between GPs, home nursing services, auxiliary care givers and volunteer groups are difficult to maintain. So far, this problem remains unsolved, and not just in sa国际传媒 No health service in sa国际传媒 has found a good answer.
So here are the questions that politicians need to deal with, whichever party wins the election.
How will you move our health-care system away from its over-reliance on hospital and emergency-room treatment, and toward preventive and community-based care?
How will you recruit more family physicians? And how will you help the frail elderly remain in their homes?
