High burden of illness a unique problem for N.S.

Committee amends Romanow, Kirby recommendations to address province's health reform needs

By Donalee Moulton

HALIFAX – Catastrophic drug coverage is one of six of fundamental needs identified by a special committee of the Medical Society of Nova Scotia.

The society's response committee to the Romanow and Kirby reports defined and commented on five other key areas it felt was of high interest to Nova Scotia: accountability and transparency, health human resources, funding, primary care reform and access to care.

The society formed the committee to provide a uniquely Nova Scotia point of view on the issues raised and the proposals put forward in the wake of the two Ottawa reports. That committee has now released its response document.

"Our purpose was to give the Nova Scotia perspective on the recommendations of Romanow and Kirby and how they affect Nova Scotia patients and Nova Scotia doctors," society president Rob Miller said in an interview.

"Nova Scotia has unique needs that must be addressed," he added. "Our specific demographics, population distribution and burden of illness differentiate us from every other province."

There were two key premises guiding the committee.

First, the committee recognized that because health care is a provincial jurisdiction, there are substantial differences in coverage and delivery.

Second, the committee acknowledged that increasing per capita funding—in the absence of other significant changes—will not address the problems Nova Scotians are currently facing.

The first premise has lead to serious differences in the health status of Nova Scotians as compared to other Canadians, Dr. Miller said. "The burden of illness is higher here. We are sicker per capita and harder to reach."

The second premise reflects a need for greater health-care infrastructure and the fallout that occurs when such infrastructure is not in place. "We already know some of the major funding agencies are discriminating against the Maritimes because of a lack of infrastructure," said Dr. Miller. "We need more money for infrastructure. We also need different solutions."

The committee, comprised of a cross-section of physicians from throughout the province, noted in its report that Nova Scotia, with its aging population, has a high burden of illness to bear.

"Putting a catastrophic drug plan into place would ease this burden. In the past, concerns about care focused on the shortage of surgeons or a lack of hospital beds but now, one-third of our population cannot afford necessary medications. Ensuring everyone has equal access to medical care will not mean anything if the patient cannot afford the medications they require," the report stated.

The committee also said the shortage of health human resources is a significant problem. "The number of health-care professionals should be based on population and regional needs. Currently, too few physicians, nurses and other health professionals are being trained to meet the needs of our system, which creates competition between provinces," the committee noted.

Human resources is an area, said Dr. Miller, where both the Romanow and Kirby reports fell short. "They have missed the boat on this. We don't (agree) there are enough health-care practitioners around, but it's just that they all want to practise in the city."

Fairness in funding

The committee also called for fairness in funding. New funding, it said, must take into account provincial demographics, regional priorities, fiscal capacity and burden of illness. It is important that the age of the population, rural distribution and infrastructure differences be considered.

"To improve the existing system, everyone agrees immediate additional funding is required, but to maintain these improvements a plan for secure funding is essential. A sustainable, affordable source for health-care funding must be identified if we are to truly reform health care. This funding, however, should not come at the expense of other portfolios, such as education or the environment, which in turn impact population health," the report stated.

The next step is to wait and see what happens at both the provincial and federal levels, said Dr. Miller, warning both governments: "We will be watching."