Part 2 of 3: The scope of health care needs
In the acute-care system model, the need for health care can be due to “acute disease conditions” such as sudden sickness, the worsening of an existing ailment and injury. Patients may require a visit to the emergency room, urgent admission to the hospital or prompt examination, either in a doctor’s office or an outpatient clinic in a hospital for diagnosis and treatment.
In contrast, “chronic disease conditions” are those that by their nature cannot be completely cured or would require much longer than days or weeks for complete recovery. Patients may require ongoing treatment and few may initially require a short period of hospitalization on a non-urgent basis.
Non-acute disease conditions do not require emergency or urgent attention. Such patients are usually scheduled for diagnostic tests and treatment and those requiring a surgical operation may necessitate admission to hospital or “day surgery.” Other health care needs include home care, cost of prescription drugs, rehabilitation and palliative care.
The above-noted understanding of health care needs assumes the presence of a disease or disability condition. But health, in its holistic meaning, is more than the absence of disease – the “medical” determinant of health.
Awareness of “non-medical” factors such as culture, income, employment and social support has serious policy implications for governments when they ask their health departments to respond to the specific health care needs of new immigrants and citizens who hold health as “encompassing mental, social, economic, and spiritual well-being,” or when they ask their finance, human resources and social services departments for policy alternatives to achieve the desired socio-economic objectives that impact on health status.
While meeting the health care needs explains the recovery of patients from sickness, disparities in social and economic status among citizens help explain why some are not healthy while others are.
Unmet health care needs
Within the disease model, health care needs may remain unmet for three categories of reasons, namely, (1) availability, (2) acceptability, and (3) accessibility. Whether they are real, only perceived, related to personal circumstances or characteristics of the health services, they have implications for intervention by health policy-makers when they consider long waiting times for treatment, crowded emergency departments, undue delay in diagnostic testing, the need for an expanded scope of health services, supply of culturally-sensitive health care professionals, modalities of health information, distribution of specialists, and regionalization of services.
Outside the disease model,the negative impact of poverty, unemployment and social isolation on the health status of a population may only be better met by policymakers in the non-health sector.
Evolution and modernization of Medicare
The Canada Health Act of 1984 is the law that enables Canada’s present Medicare system. It is a story of struggle that nearly ended in its death, of political leadership that transcended partisan colours, and of health that triumphed as a public good. Understanding the milestones of its evolution should help inform and frame the current dialogue about its future in search of excellence in care and sustainability:
1919, August 16 – Fresh from the harsh lessons learned from World War I, the Liberal Party adopted a policy resolution on health that called on the federal, in cooperation with the provincial governments, to establish an insurance system against the cost of illness.
1944, March 31 – Liberals introduced in Saskatchewan the legislation, A Bill Respecting Health Insurance, which was unanimously adopted.
1947, January 1 – Saskatchewan Premier Tommy Douglas, introduced the first universal comprehensive health insurance system in North America.
1957 – Parliament, on the initiative of Conservative John Diefenbaker, passed the Hospital Insurance and Diagnostic Services Act, which guaranteed 50% federal funding of provincial hospital-insurance programs.
1961 – All provinces accepted the federal lead.
1961, June 20– The federal government established the Royal Commission on Health Services headed by Justice Emmett Hall.
1962, July 1 – Premier Tommy Douglas – now acknowledged as the Father of Medicare – extended coverage to include physician services. A number of medical doctors left the province in protest and those who stayed went on strike.
1964 – Justice Emmett Hall recommended establishing a national health insurance plan.
1966 – The federal government under Lester B. Pearson passed the Medical Care Act with five national standards.
1972 – All provinces and territories participated.
1980 – Extra billing posed a threat to the Medical Care Act. Justice Emmett Hall undertook a second Commission and recommended ending extra-billing by health facilities and doctors.
1984 – Canada Health Act
In part thee of this series: Securing the future.
Dr. Rey D. Pagtakhan – a former Professor at the University of Manitoba Faculty of Medicine, Member of Parliament and senior federal minister – is widely published and lectured in Medicine and Politics and has received many awards and honours, including the honorary Doctor of Science and Doctor of Laws.