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As the name implies, our health care system covers many, but not all of our health needs. It is provincially administered and the federal government contributes to its financing.

But, contrary to what many people believe, long term care services do not fall under the Canada Health System. In some ways however, the provinces provide some protection or insurance, if you will, against the cost of long term care by funding the major portion of the care costs. Unlike the United States, where skilled nursing can cost $200 or more per day, the provinces pay almost $100 toward care and even provide support to the most needy toward their "room and board" or resident co-payment.

That’s one of the reasons we have so much diversity across Canada - in the cost and type of services that are provided, in the terminology used and in the patchwork of regulation that governs the services provided.

Insurance is meant to protect people in times of unforeseen or catastrophic events: automobile insurance (for car accidents), life insurance (for death) and disability insurance (for physical injury).

Our Canadian health insurance does more than just protect us against the cost of health care after a serious accident or a bout with cancer. It covers the costs associated with checkups, X-rays and even frivolous visits to an emergency room

We have all heard and read that the current system is not sustainable. And the problem will only get worse. The growth in the senior segment will result in exponential growth in our health care needs because, as we all know, seniors require more health care - hospital care, rehabilitation and the like, than the younger segments of the population.

The problem occurs because health care covers both catastrophic health expenses and discretionary spending. If we divorced the discretionary spending from catastrophic expenses, people would be covered in extreme situations but left to pay for minor problems, so long as they can afford to do so. In a recent interview, Ontario’s health minister indicated that the proposed sharing of costs by users of home care was a reasonable way of sharing the cost for those who can afford to do so.

The other major proposal is for better sharing and coordination of information and services. In this way we can eliminate many of the errors in medications, share and use best practices to become more productive, more efficient and more effective.

I would suggest another problem that needs to be overcome - the understanding and recognition that all of the players meet the needs of seniors and are an important part of the system - private and public, for profit and not-for-profit. They’re all part of the solution.

An example:

In Ontario, in the absence of new long term care beds between 1986 and 2003, which resulted in increased wait lists, the private sector stepped in and met the need by creating 16,000 new, private pay retirement care beds. But, while they provided assisted living and met the needs of seniors and were part of the "continuum" in meeting the needs of seniors, nowhere were they recognized as such in any of the Hospital Restructuring Reports of the time. That was in the mid 1990's. They were "self-regulated" in the years up to 2011 with strong consumer protection and complaints mechanisms.

Given that people's demands will far outstrip supply, even in the wealthiest nations, health services rationing, achieved through restricting supply, through waiting lists is not the answer, because that causes problems elsewhere - with families, with productivity losses, with stresses that will be felt in other parts of the health care system.


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