Better home care and better pay for doctors urged at CMA town hall.

Even on a cold winter night, it seems Canadians can’t resist the promise of an earnest evening of debate over medicare reform: With 500 people in the room and another 150 turned away Tuesday in Toronto, Ontario, at the Canadian Medical Association’s second town hall meeting on health care transformation, it’s evident that a passion for public health persists in Canada’s biggest city. In a two-hour session structured to allow ample commentary from a crowd heavily stocked with health professionals, CMA President Dr. Jeff Turnbull and a panel including Ontario Medical Association President Dr. Mark MacLeod contended with a barrage of calls for sweeping reforms to sizeable portions of Canada’s universal access health care system. The aim of the exercise, according to Turnbull, was to get “everyone around the table” and encourage a little public dialogue — but no ranting, please — on central issues such as the role of the federal government in health care, and how the Canada Health Act might be refashioned. Both issues elicited forceful discussion (and just a few rants) about the need to expand public health to include pharmacare and homecare, and the need to shift the current focus from acute care toward chronic care. Secondary themes included the need to develop greater transparency and accountability in health care, and the need to invest in electronic information technologies. “Too many seniors are slipping through the cracks. They inevitably wind up in emergency wards,” warned Toronto physician Dr. Mark Nowaczynski. “Why isn’t home health care in the Canada Health Act?” A major reason patients are not treated in their homes, Nowaczynski explained, is that under current pay schemes, care providers wind up receiving around 40% less pay for the extra time and effort required to get out of their offices and into patients’ homes. “We need to make a business case for doing home care,” Nowaczynski urged. “It’s just too hard to sell interns and doctors on a pay cut.” MacLeod concurred, noting that up to 20% of Ontario hospital beds “are occupied by people who could be treated at home or in other institutions.” In order to encourage doctors to treat people at home, governments will have to reform payment models, he argued. The home care quandary, many participants noted, reflects demographic patterns in which increasing numbers of aging patients now require escalating levels of costly care. “The system has not changed but the population has,” suggested Dr. Samir Sinha, director of geriatrics at Mount Sinai Hospital in Toronto. Meanwhile, there are only about 200 geriatricians practicing in Canada, about one-quarter the statistically appropriate number, Sinha said. Here again, pay structures serve as disincentives for physicians working with the elderly, he complained.