In a policy document released Tuesday, the Canadian Medical Association called for a number of system-wide changes, including universal access to prescription drugs, incentives to shorten wait times and broader adoption of electronic health information technology.
The paper, entitled "Health Care Transformation in Canada: Change that Works. Care that Lasts," urges the public, Ottawa and the provincial and territorial governments to look beyond the "narrowly interpreted parameters" of the 1984 Canada Health Act to update medicare for the 21st century.
"Our system of publicly funded health care is founded on the promise that all Canadians will receive needed medical care when and where they need it," said CMA president Dr. Anne Doig. "Far too often, the promise falls short."
"The present system will not be able to meet future needs ... We need health care transformation and we need it now."
Doig said there is a need to identify and correct the "gaping holes in the continuum of care" that many Canadians experience while trying to navigate the health-care system.
Residents of every jurisdiction in the country should have equal access to prescription drugs, she said. "There is a patchwork of coverage available to Canadians in the various provinces and territories, ranging from fairly comprehensive coverage in the province of Quebec down to some of the other provinces, notably (in) Atlantic Canada, where there are quite serious deficiencies."
Another area that needs urgent attention is providing support for family members who care for loved ones who've been discharged from hospital following surgery or illness, as well as provision of non-hospital facilities for patients unable to care for themselves at home.
Though somewhat controversial, the CMA is also urging governments to provide incentives — financial and otherwise — to bolster the delivery of Canada's most cherished social program.
"The concept is to reward quality of care and efficiency of care," said Doig. "This is not about giving personal cash incentives to pay practitioners. This is about using system incentives ... so it encourages the caregivers collectively and the institution collectively to do a better job for patients."
The CMA also wants billions of dollars earmarked for strategies to shorten wait times to go beyond specific areas like cardiac care, cataract surgery and hip replacements.
"What we really need to do is look holistically at the system and say what are the impediments to access, regardless of whether we're talking about access to a primary-care physician ... engaging a specialist for consultation or sending the patient to have an advanced diagnostic or further down the road to that patient requiring definitive care."
Doig said Saskatchewan, for example, has been working on improving patient care at each step of the process from diagnosis to treatment through follow-up care.
"The whole point of this is to see this through the eyes of the patient," said Doig, a family practitioner who works in a multi-doctor clinic in Saskatoon. "What does it look like as a patient if I go to see my doctor with a tummy ache and how long does it take my family doctor to sort out the tummy ache and figure out if I need to see a gastroenterologist or have a scope done or see a surgeon?"
"That's what we're talking about, is trying to make this through the eyes of the patient as seamless, as continuous and as comprehensive as we can."
Electronic medical records, both in hospitals and in physicians' offices, would also improve the system, the CMA contends. However, many doctors have been slow to adopt e-health technology in their practices, primarily because current medical software does not fit their needs, said Doig.
"The issue here is finding technology that works," she said. "Probably the biggest impediment to uptake of electronic records ... (is) the focus on building the information superhighway," instead of targeting the point of care — the doctors themselves.
"The problem has been we tried in Canada to go top-down, and what we need to do is start at the bottom and build up from the base," said Doig, who believes current technology does not yet allow physicians to write prescriptions, order tests and enter results in patient charts with "minimal risk of error."
Still, Doig said any discussion about how Canada's medicare system should be reconfigured must begin with its end users.
"The point is to try to encourage Canadians to let go of some of the complacency and some of the attitude that they've had that 'We've got the best system in the world, so therefore we have to accept its shortcomings,'" said Doig.
"In fact, what we're telling you is we've got good care ... we've got good things and good people in our system. But we can do much better."
"And we need Canadians to tell us: What is it you don't like? What would you like to see done better?"