Tough health care questions need answers - Dr. Peter Zalan

On Dec. 10, Health Sciences North will be introducing to the community its new Research Institute. Its mandate: to focus on finding advancements in the treatment of geriatric care, chronic and infectious diseases, and cancer.

I would add to the list: ethics.
Health care is the Ontario government’s biggest program. Yet the list of services not fully covered is long: out-of-hospital drugs, home care, psychological counselling, ambulance services, addiction treatment, long-term care, eye care and dental care.

Almost 35 per cent of the health budget is spent on hospitals. The passage of the Medical Care Act in 1966 meant having access to all medically necessary physician services provided in offices and in hospitals.

Since then, there have been repeated, but unrealized calls for the creation of a national home care program and the promotion of primary care and prevention strategies to the forefront of the health care system.

The cost of health care is driven by inflation, population growth, aging, new technologies, new drugs and increasing utilization: just think of the increasing demand for joint replacement.

In Ontario, satisfying these demands will require an annual increase in the health budget of 7.7 per cent. Nevertheless, Ontario has budgeted for a 2.5 per cent yearly increase, in an effort to return to balanced budgets.

Canadian and US studies have estimated more than 20 per cent of all health-care spending finances treatment in the last six months of life.

The largest costs turn out to be for patients with repeated admissions for acute hospital care. So according to these numbers, one per cent of Ontario’s population accounts for 49 per cent of costs.

In Sudbury, there is a shortage of adequate housing for economically disadvantaged elderly. The beds at the old Memorial site are to close at the end of January.

The province is not building additional long-term care beds. There are waiting lists for home care and home physiotherapy. Many patients are without a family physician.

Our emergency department has long wait times and suffers from chronic overcrowding. ALC patients occupy beds meant for acute care. There are long wait times for many types of elective surgery.

Next year, Health Sciences North expects no budget increase even though costs are expected to increase by two to three per cent.

So, is there need for rationing of health care services? What process should we use for the introduction of new technologies and drugs, especially for those that are both beneficial and expensive? How should we deal with the high needs of the few at the expense of the many?

How can we provide patients and families sufficient information and time to make informed choices during complex circumstances? How can we identify patients who are at high risk of poor outcomes prior to initiating high-technology procedures and treatments?

Should we be changing the priority from high-technology hospital care to the promotion of first-class care in the community?

Questioning the primary goals of medicine and the health-care system is necessary. The enterprise of medicine is becoming increasingly difficult to afford. Governments are experiencing increasing difficulty meeting the expectations of their electorates.

Ethics presents alternatives. It considers what is “right” and what is “wrong.” It offers an approach for deciding what should be done: to do the most good, the least harm, in a fair and equitable manner. Done with compassion and in good faith.

Dr. Peter Zalan is president of the medical staff at Health Sciences North. His monthly column tackles issues in health care from a local perspective.