{"id":292775,"date":"2016-01-11T17:18:13","date_gmt":"2016-01-11T22:18:13","guid":{"rendered":"https:\/\/policyoptions.irpp.org\/2016\/01\/what-should-be-covered-by-our-publicly-funded-healthcare-system\/"},"modified":"2025-08-28T15:24:41","modified_gmt":"2025-08-28T19:24:41","slug":"what-should-be-covered-by-our-publicly-funded-healthcare-system","status":"publish","type":"post","link":"https:\/\/policyoptions.irpp.org\/fr\/2016\/01\/what-should-be-covered-by-our-publicly-funded-healthcare-system\/","title":{"rendered":"What should be covered by our publicly funded healthcare system?"},"content":{"rendered":"

All across Canada provincial governments are grappling with ever growing healthcare demands in the face of shrinking resources.\u00a0 Our enviable publicly funded health system is now well into a downward spiral of unenviable disrepair.\u00a0 As patients are becoming more knowledgeable about their own care, and as doctors develop a wider array of options available to treat diseases, the costs are increasing.<\/p>\n

The truth is, we can\u2019t have it all.\u00a0 Both the physicians who deliver care and the patients who receive it need to start considering the concept of limited resources in our publicly funded healthcare system.<\/p>\n

One of the main tenets of the Canada Health Act is that medically necessary care should be insured by public funds and that all related hospital or physician care should be paid for by the public system.\u00a0 This is the soul of the cherished notion of \u201cfree\u201d healthcare that most Canadians hold so dearly.<\/p>\n

But the tricky thing is that the Canada Health Act does not actually define what constitutes \u201cmedically necessary care.\u201d\u00a0 This is left up to the individual health providers to determine, on a case-by-case basis.<\/p>\n

At first glance it might seem easy to distinguish \u201cmedically necessary\u201d care from optional care.\u00a0 If a patient is sick, then the treatment needed to fix the problem is intuitively considered necessary \u2013 the idea being that medical needs dictate what will be provided by the public system.<\/p>\n

And in some circumstances, determining what is \u201cmedically necessary\u201d is easy.\u00a0 Both patients and doctors could likely agree that if you have cancer, it needs medical treatment.\u00a0 If you have fractures from a car accident, they need to be fixed.<\/p>\n

Likewise there are many other examples that most of us could agree fall into \u2018optional\u2019 care, such as laser eye surgery to remove the need for glasses or cosmetic facial surgery \u2013 wants, not needs, that don\u2019t merit public funding.<\/p>\n

In between these examples, though, is a wide gray area where distinguishing need from want is not nearly so clear.\u00a0 Is fixing an annoying nasal blockage a need or a want?\u00a0 Is getting arthroscopy for a sore knee a need or a want?\u00a0 How about a patient who wants blood tests that aren\u2019t medically indicated, but they are just curious?<\/p>\n

Non-essential care is by no means limited to patient demand.\u00a0 There also exists a vast array of low-quality or low-impact health interventions initiated by doctors \u2013 and publicly funded.\u00a0 Many of these interventions are not supported by evidence. That blood test or chest x-ray your physician ordered for you before your elective operation?\u00a0 Very possibly unnecessary<\/a>.\u00a0 The CT scan you had for pain in your lower back? The evidence says it will not improve your outcomes<\/a>. \u00a0The antibiotics you were prescribed for a persistent virus? Unnecessary<\/a> and they won\u2019t work anyway.<\/p>\n

Tests and treatments like these examples, and others, are not medically necessary and they are also costly to the struggling healthcare system.\u00a0 In fact, unnecessary tests can expose patients to harm because of false-positive rates.\u00a0 The \u201cChoosing Wisely Canada<\/a>\u201d initiative spearheaded by the Canadian Medical Association is just beginning to explore the massive scope of unnecessary care and the impact it has on patients and the health system.<\/p>\n

Are doctors too often offering to use public funds to investigate or treat problems that are wants versus needs and not actually medically necessary? \u00a0Are patients losing sight of the fact that no province has the funds to provide all care for all people all the time?<\/p>\n

Our contemporary free-for-all style of healthcare, a challenge on both sides of the medical consultation room, is totally unsustainable on the public purse.<\/p>\n

Doctors need to start openly and directly considering the concept of medical necessity when talking with patients about tests or procedures.\u00a0 Patients, in turn, need to keep in mind that their healthcare is not \u201cfree,\u201d and that many of their health-related complaints likely represent wants, rather than needs.<\/p>\n

Working together we can salvage what is left of public healthcare in this country, but only if both groups promptly adopt a more realistic attitude toward medical necessity.<\/p>\n

From EvidenceNetwork.ca<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

All across Canada provincial governments are grappling with ever growing healthcare demands in the face of shrinking resources.\u00a0 Our enviable publicly funded health system is now well into a downward spiral of unenviable disrepair.\u00a0 As patients are becoming more knowledgeable about their own care, and as doctors develop a wider array of options available to […]<\/p>\n","protected":false},"author":913,"featured_media":292773,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"content-type":"","ep_exclude_from_search":false,"footnotes":""},"categories":[],"tags":[],"article-status":[],"irpp-category":[],"section":[],"irpp-tag":[],"class_list":["post-292775","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry"],"acf":[],"yoast_head":"\nWhat should be covered by our publicly funded healthcare system?<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, 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