While Nova Scotians languish in emergency departments, wait patiently to see medical specialists, grieve over injuries from health system mistakes, and suffer while waiting for surgery, the Nova Scotia government is asking for comments on proposed new medicare legislation.
Yet the draft Health Services and Insurance Act does not address the key problems afflicting medicare in Nova Scotia. Instead, it continues the heartrending story of delayed care, lack of accountability and failed governance, including tolerance for errors leading to unnecessary discomfort, disability and death.
The legislation introduces a violation of standard privacy protection rules. The minister of health would be able to appoint someone to assess your personal health record without telling you or asking for permission. The purpose of the review would be to learn if your doctor submitted the correct bill. Of course, the minister’s office could just ask you. The legislation continues the ban preventing individuals from purchasing necessary and reasonable care, when timely government insured services are not available.
The proposed legislation ignores the features of medicare that benefit patients, namely universality, accessibility, portability and comprehensiveness. Instead, it concentrates on public administration, the feature most helpful to the government.
The Canada Health Act requires universal health care on equal terms for all Nova Scotians (something that might be difficult in any circumstance). However, the proposed legislation is silent on the current government-supported two-tier system that favours some patients and physicians over others. Indeed, the proposed law forbids most Nova Scotians from buying access to the same, more expensive and better care, that many Nova Scotians experience at government expense.
Government pays directly or through the districts the full costs for a few family medicine clinics where patients have access to family practice nurses, information technology and personalized telephone advice. Nova Scotia cannot or will not pay all primary care clinics in the same way as the preferred ones.
People in the top tier of government-funded care are able to talk with clinicians over the telephone or communicate by email and, where appropriate, get prescription renewals by phone. Most other people cannot get laboratory results over the telephone, or email or telephone advice from doctors and nurses in their own practice. Rather, after hours, those people who are not privileged must call 811 for advice from a nurse who does not know you or your personal circumstances. Would it not be better if you could call a doctor or nurse who knows you, even if it means that you have to pay to receive the same care as your neighbours get for free?
The accessibility clause requires that insured services be provided on a basis that does not impede or prevent reasonable access to those services. According to information from Capital Health, government is maintaining the tradition of denying Nova Scotians timely access and forcing some people to suffer through painfully long waits for care.
If you have a sprained ankle, care is available immediately, but you might have a terribly long wait for expensive knee or hip surgery. In June 2012, Capital Health reported that the waiting time for a diagnostic test, such as an MRI, is longer than 32 weeks, or eight times longer than the four-week target. If you need radiotherapy or semi-urgent open-heart cardiac surgery, you are also likely to have an unacceptable wait. Most Nova Scotians know from personal experience that the waiting times in emergency departments (where a local emergency department is even available) are often uncomfortable and long.
In June, government, as regulator and insurer of health services, was silent when Capital Health reported its unambitious goal “to increase the percentage of patients who have their orthopedic surgical procedures within the target wait times to 50 per cent by 2011-12.” When government advertises “Better Care Sooner,” you should ask “Why not now?” And “Why can’t I pay for the care I need rather than suffer when government insists on making people suffer by rationing care?”
The portability clause of the Canada Health Act requires that provinces “must not impose waiting periods for coverage of more than three months.” Nova Scotia fails with respect to portability. Sick patients could wait months or years, depending on their condition, to use Nova Scotia medicare. Registering for medicare is not the same as having access to care; and access to timely, comprehensive and excellent care does not seem at all important in the proposed new rules.
The new act makes no mention of accountability (not a feature of the Canada Health Act) and continues the Nova Scotia habit of ignoring serious quality issues. Capital Health participated in the 2004 Canadian Adverse Events study that showed that many people suffer unnecessary death, disability and dysfunction from preventable mistakes, and the Nova Scotia government, as a regulator, still has not asked and answered whether Nova Scotia hospitals are better, worse, or the same as in 2004.
Government is proposing new health legislation. Write your MLA if you are disturbed by a system that prevents you from getting excellent care. Write to your MLA if you do not have access to a family doctor, or if you cannot consult with your doctor over the telephone or by email. Write now if you have to wait a long time to see a specialist or for necessary surgery. Tell government if a health system error has harmed you, a friend or a relative. Ask how the new legislation will improve your life.
David Zitner, a family physician, is Health Policy Fellow with the Atlantic Institute for Market Studies and a professor in the Dalhousie Faculty of Medicine.