Published in the Telegraph-Journal 10th February 2012
A heated discussion is emerging on what the future of healthcare will look like. In Canada, healthcare systems, which were created during a period of prosperity, are now facing severe economic challenges. Even though we are faced with a global financial crisis that jeopardizes our financial stability, the early 21st century is a marvel of achievement in scientific advancement and technological progress. However, the financial foundations of healthcare are crumbling and could weaken further unless policies are quickly revised. The fundamental problem of healthcare is its spiraling cost, and there is no end in sight. Governments are beginning to review how to slow this upward spiral, but there is little agreement on how best to achieve this.
Perhaps the most critical question is how healthcare systems can be redesigned without damaging the foundation upon which they were originally developed. Founded on the principle of universality, Canada’s healthcare system is paid for by the public, with the risks of medical expenditures essentially shared. There is substantial evidence that most Canadians agree with this shared-risk principle even if they are uncertain about how rising costs are to be met. Most would resist any efforts to change the current system. Many think radical change would jeopardize the principle of universal healthcare coverage. However, the financial contributions required for healthcare have risen steadily, to the point where people are beginning to realize that further increases may no longer be possible. Governments, for their part, are beginning to recognize that continually rising costs will not be politically acceptable. Even so, the increase in the cost of healthcare continues to outdistance economic growth and shows no sign of slowing down.
In fact, healthcare costs are rising far more quickly than levels of available funding. These rising costs cannot be met with current levels of public funding and these costs cannot be met by raising taxes either, in part because the costs have become far greater than conventional taxes could generate. In New Brunswick, the main drivers of rising healthcare costs point squarely to the impact of aging populations and the related rise in chronic disease, as well as costly technological and pharmaceutical advances. And in today’s Internet culture, patient demand increasingly is being driven by a greater knowledge of options. Underlying all of this is the effect of less healthy lifestyles that has led to increasing incidence of obesity-related conditions such as heart disease and diabetes.
In the face of these challenges, governments and healthcare agencies are encumbered by legacy priorities and financing structures that are ill-suited to today’s requirements. But a consensus is beginning to emerge that the future of healthcare will be shaped by a number of separate, but interconnected, trends. A key trend is that healthcare spending will continue to rise, not only because of inflationary drivers, but because of a growing recognition by policymakers that improved health is strongly linked with greater national wealth. It is a paradox that without financial constraint, maintaining the universal healthcare model may require the rationing of services and consolidation of healthcare facilities, as public resources no longer are able to meet demand.
These trends have significant implications for governments and the public? Ultimately, patients may need to take more responsibility for their own health, treatment and care. More effective preventive measures and fundamental lifestyle changes should be promoted to encourage healthy behavior. Governments will need to wrestle with bureaucracy and liberalize rules that restrict the roles of healthcare professionals and that artificially increase the cost of healthcare research. In the future debate about the details of healthcare reform in New Brunswick, what will be needed most is adaptability to focus on the best ways to maximize the health and well-being of New Brunswick’s population.