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Zalan: Latest gov’t report paints dark picture of the state of our health care system

Inadequate home care, too many people living (and dying) in hospitals, lack of coverage for physiotherapy and more: the province didn’t prepare for the future, and now the future is here
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Health Quality Ontario, a government agency, has published its 2017 report, the 11th year of reporting on the performance of our health care system. In a number of areas performance is failing to improve or getting worse.

There are almost 4,000 patients who currently live in hospitals, some in sunrooms and hallways, who no longer need the services of an acute care hospital. This is largely due to a lack of long-term-care beds (LTC) and home-care spots. In response, the Ontario government announced that it will add almost 2,000 temporary beds, guaranteed until March 31, 2018.

This sudden reverse in policy occurs after years of frozen funding for hospitals and lack of construction of new LTC beds. 

More home-care patients are requiring increasingly more care. Services are not keeping up with the demand. Caregiver distress is growing among those looking after for their loved ones at home.

Mental health services are also not meeting demand.

A study looked at visits to the emergency department for depression in women following birth of a new child. Sixty per cent had not received mental health care from a doctor since delivery the previous year. There were similar outcomes for children and youth with a mental health condition.

Among Ontarians who reported needing mental health care within the preceding year, more than one-third said their need was either unmet or only partially met. There has been no improvement in this indicator for nine years. 

Most people noted they had a family doctor or nurse practioner. But only 57 per cent had reliable access to a provider who knew them well. Less than half reported being able to get an appointment on the same or next day when they were sick (only 22 per cent in northeastern Ontario). 

A real-life example: John has chronic obstructive lung disease. He is 63. He has smoked for many years. He gets increasingly short of breath when he walks too fast. He has been in hospital with pneumonia twice in the last two years. The last time, he needed to be admitted to the intensive care unit for three days.

For John, careful, ongoing monitoring in the community beginning right after discharge from hospital, by a provider who knows his history, is crucial to maintain the quality of his life. What will happen if John cannot get an appointment for two weeks when he develops his next chest infection?

Most people in Ontario say they would prefer to die at home. Nevertheless, the majority of people still die in hospital. In Sudbury, we are fortunate to have Maison McCulloch Hospice, which offers palliative home care.

Although Canada’s Medicare is thought to be universal and comprehensive, one-third of health-care spending is private. For many important services, there is no free health care, including dental care, long-term care, physiotherapy, some home-care services and psychotherapy. Not to mention access to adequate nutrition and safe housing. Nearly 62 per cent of the money spent on drugs per person in Ontario comes from private sources.

What will likely happen if John cannot afford to purchase his medications in the community after discharge from his free stay in the intensive care unit? This is the picture that Health Quality Ontario paints. 

When compared to other wealthy countries, our health-care system is ranked as mediocre when measured for quality. This is in spite of being considered expensive. Check out the comparison of 14 countries at  CommonWealthFund.org. (http://www.commonwealthfund.org/publications/chartbooks/2016/multinational-comparisons-2016)

The last Canadian census reported the number of Canadians over 85 years of age increased by 19 per cent in the last five years. Folks older than 100 were the fastest-growing population from 2011 to 2016 — by a whopping 41 per cent.

It is awesome so many of us can live a long life. But seniors need more care than when they were 25. Many of these needs remain unmet, as outlined above. 

Successive Ontario governments failed to plan for the future. And the future is here.

Dr. Peter Zalan is past president of the medical staff at Health Sciences North. His monthly column tackles issues in health care from a local perspective. If you have a question for Dr. Zalan, email it to editor@sudbury.com.



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