Monday, September 28, 2015

Health Care for Seniors

Two questions raised by Donna McCaw in a recent article merit some consideration. The second question is about serving the health needs of seniors

Canada still does not have any health policy at the federal or provincial levels to deal with an aging population. Baby Boomers may be healthier than the previous generation but subject to the slings and arrows of outrageous health fortune like others

My accountant told me that the biggest risk he sees in his older clients is lack of planning about health care. About two thirds of Canadians cite health as their biggest concern as they age but only about 22 per cent have planned or saved for a medical issue. 

A federal election is on the horizon but discussion or policy suggestions for health care for the coming increase in the aging population is not. Not yet, anyway.  The Canada Health Act is federal legislation which deals with transfer payments to the provinces who then organize and deliver care.  Those transfer payments are not increasing.

The number of dementia patients is expected to double by 2031 to 1.4 million putting great pressure on families and facilities and yet we have no plan.  Bill C-356, a bill to address some of the realities of dementia care, was proposed in 2011 and reached second reading in December of 2014 but it may fall by the wayside as we go to a Federal election.

The Canada Health Act (the Act), proclaimed in 1985, sets out the framework for Canada’s a national health insurance program. Although there is one national Act, the insurance programs that fund the services that make up the public health care system across Canada, are in fact 13 provincial and territorial plans. The Act sets out the common features that each provincial/territorial plan must meet for the province/territory to be entitled to its full share of funding from the federal government.

Our current government has taken steps to dismantle the Canadian Health Act by severely cutting funding. Prime Minister Harper turned this on its head by tabling a budget that will use federal transfers in order to eliminate national standards in health care.

Buried on page 279 of the 2014 federal budget is a measure that will make it next to impossible for provinces to provide health care services on equal terms and conditions. The purpose of this budget item is to strike a blow to the heart and soul of universal health care in Canada.

The Harper government is eliminating the equalization portion of the Canada Health Transfer (CHT) and replacing it with an equal per capita transfer. This means that less populous provinces with relatively larger and more isolated populations will have more and more difficulty delivering more expensive universal health service

Justice Emmett Hall, a principal architect of national health care in Canada, articulated the platform required to realize a national health care system. In order to establish and achieve high national standards for health services, the federal government needed to establish a funding formula that took into account the capacity of provinces (and territories) to achieve national standards. In other words: no equalization in health transfers, no national Medicare.

This regressive budgetary change will be matched with a second regressive measure. Beginning in 2017, the six percent annual increase for the health transfer will be replaced with a formula that links the health transfer to economic growth. This means that in times of high unemployment and economic downturn – when Canadians need access to care the most – the federal transfer will be reduced. This measure alone will result in a $36 billion cut in federal funding for health care over the next decade.

With Harper’s cuts to health care funding, the share of federal CHT cash payments in provincial-territorial health spending will decrease substantially from 20.4 per cent in 2010-11 to less than 12% over the next 25 years. This, according to the Parliamentary Budget Office, will bring the level of federal cash support for health care to historical lows. National Medicare was implemented across Canada by provinces and territories on the understanding that the federal government would contribute roughly 50 percent of the spending on Medicare.

The shrinking level of federal funding for health care will be matched by a withdrawal of federal enforcement of national standards contained in the Canada Health Act. The use of the spending power to establish national standards is common in all OECD federations. National Medicare will clearly not survive this ‘cut and run’ course being set by the Harper government. Instead, it will fragment into 14 separate pieces where access to essential care will depend on where you live and your ability to pay.

What does this mean for seniors who have come to rely on having a strong national health system? Health Care in Canada, 2011: A Focus on Seniors and Aging has some ideas Many seniors depend on strong primary health care and prescription medications to help manage an increasingly complex mix of health conditions and protect their health. While the majority of Canadians (95%) older than age 65 have a regular family doctor, some reported challenges accessing their doctor when they needed care. Visits to family doctors are more frequent among seniors with multiple chronic conditions.

Survey findings show that it is the increasing number of chronic conditions, rather than increasing age, that drives primary health care use. Data on the use of prescription medication echoes these findings, with the proportion of seniors taking multiple prescription medications rising in recent years. Nearly two-thirds of seniors on public drug programs have claims for 5 or more drugs from different drug classes, and nearly one-quarter have claims for 10 or more. More than half of seniors on public drug programs regularly use prescription drugs to treat two or more chronic conditions, and among this group, the most commonly used medications were for treating high blood pressure and heart failure (used by 65% of this group).

Health spending per capita on seniors is more than four times that of non-senior adults (age 20 to 64 years) in absolute terms, the rate of spending growth for seniors was actually lower over the past 10 years than the rates for non-senior adults.

Over the last decade, population aging has contributed relatively modestly to rising public-sector health care spending, adding less than 1% to public-sector health spending each year.

This result may appear counter intuitive when considering seniors’ use of health care services; compared with non-senior adults, seniors are proportionately higher users of hospital and physician services, home and continuing care, and prescription drugs.

The increasing number of seniors itself will not threaten Canada’s health care system, but it will require the system to adapt to meet changing health care needs. Among those challenges: to what extent the Canadian health care system has met seniors’ needs to date, how it will likely need to adapt to continue to meet these needs into the future and how Canadians’ health care needs may change as the population shifts over the next 20 to 30 years. However for this to happen we need to have strong Federal government support not a government which cuts transfer payments and weakens our Health Care programs across Canada.

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