Nine members of the CHRISTUS Health Futures Task Force II committee (including myself) participated in a four-day scout trip to Toronto, Canada from May 28-April 2. The purpose of this “learning journey” was to explore the strengths and weaknesses of the Canadian health care system, learn form the Canadian experience with multiculturalism and diversity, learn from Toronto’s experience during the SARS pandemic experienced in 2003 and further explore examples of innovation.
Over the next few weeks, I will dedicate my blog to each of these areas, highlighting the common themes which emerged from this trip, including:
*That cooperation and collaboration in emerging global business models is possible
*There is value in partnershipping with what once seemed like unlikely allies
*Individuals are catalysts for change, but communities are required to make things of significance happen. It is important to identify the leverage points for changing critical elements of the system rather than taking on the whole system and failing.
*Innovation and the creation of new solutions through the innovative processes require significant input and dialogue with others.
Let us now look at our learnings regarding the Canadian health care system. In a prior blog post, I mentioned the five components that are required for a successful universal health care system. And I was pleased to find that the Canadian health system embraced them all, to a significant degree.
Clearly, they are committed to providing basic health coverage for all and do such through governmental funding. This includes full payment of standardized charges for hospitals and physicians. In addition, they have addressed outpatient care through establishing models called community health centers. Resources in communities must come together to create a business plan to implement these centers, submitting a request for funding to both regional and federal governmental bodies. If they meet all the requirements for a multi-faceted approach to health care including prevention and education, these are always funded to the requested levels.
Each of these centers must provide all their care in outpatient settings and provide social services to address the nonphysical needs of each and every patient. In addition, they must collaborate with schools in their areas to support health care education as well as collaborating with other agencies to provide a full range of preventive health care.
Clearly, these embrace the five building blocks I reviewed before and referred to above. The health care profession in Canada has a clear understanding that there are seven major determinants of health, only two of which are physicians and hospitals, thereby recognizing the importance of these other building blocks. It is clear that through this governmental funding, then, most basic health care and preventive health care can be provided through these community centers, and basic inpatient and physician care can additionally be provided and reimbursed through their present physician office and hospital networks. It was interesting to note that Canada also provides this level of care for all immigrants into their country. This is key, since Canada encourages immigration from other countries to meet their employment needs, and at the present time, there are over 47 nationalities which represent more than 50 percent of the Canadian population.
In addition, this requires that in providing this basic inpatient and outpatient care, health care professionals must develop a high level of cultural competencies in order to care for and meet the expectations of these diverse cultures. One such example of this sophistication is the presence of clinics we visited that only serve members of the Aborigine tribes and their descendents or spouses.
As you might know, these tribes were significantly disadvantaged when Canada was inhabited by the French, just as Native Americans were significantly disadvantaged in the U.S. The Aborigines, like all Indian tribes, relied heavily on medicine men and women, who used natural remedies including many herbs in their healing processes and ceremonies. Recognizing the importance of this tradition and firmly-held belief by this diverse population that these treatment modalities are important, the centers serving these tribes fully integrate both traditional and these alternate types of medical therapies.
A psychiatric patient, for instance, is seen not only by a certified Psychiatrist and/or Psychologist, but would also be given complimentary herbal medicine and might participate in a chanting or drum ceremony to deal with the negative spirits which are contributing to their disease process.
Recognizing that maintaining and enhancing the knowledge of this naturalistic medicine is important, Canada has one of only five certified medical schools which grant a Doctor of Natural Medicine degree. We visited this facility and saw first-hand how again these skills are taught, studied and monitored to make sure they are bringing added value to the total health care package.
If what we have discussed this far seems ideal, then what are the cons of a universally provided system of basic health care? Clearly, we saw the same thing in Canada that is experienced in other countries that provide universal health care. That is, that the majority of dollars which are required to fund basic health care for all leaves little money to support specialty care, especially elective specialty care, which would include procedures such as joint replacements and cosmetic surgeries.
In Canada, like England and Ireland and other European countries, an insurance system has been developed so those people who can afford it can buy coverage for this specialty care or pay cash out of pocket at the time the services are rendered.
For those without this layer of coverage, specialty care is never denied, but does force them to take their place in what can become rather long waiting lines before their treatment is received. So what does this tell us about how we might proceed with the redesign of health care if any of us are invited to come to the table for a hopefully new health care design commission that will be mandated by the new President of the U.S.? I would suggest it reinforces the following:
1. The five building blocks are the right ones, and are essential.
2. Most of health care can be rendered in outpatient settings by not only medical doctors, but other health care professionals as well.
3. There is probably a significant place for naturalistic medicine or alternative, complementary medicine.
4. The more focus on preventive health care, the less cost will be required for diagnosis and treatment.
5. If the guidelines are clear and standardized as to what is required in community health centers, the talent in communities can organize themselves to implement such centers after funding is received.
Whether revolutionary or evolutionary, health care in the U.S. must be redesigned, and learning journeys such as the one we experienced in Canada are a great way of learning the best practices in providing universal health care as well as preventing us from incorporating those things that do not work into the plan.