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The Evolving Role of Community Health Centres in Canada's Publicly Funded Health Care System

Monday, September 16, 2019   (0 Comments)
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From Coverage to Access and Impact: The Evolving Role of Community Health Centres in Canada’s Publicly Funded Health Care System

 

 

By Grey Showler, President, British Columbia Association of Community Health Centres and Scott Wolfe, Executive Director, Canadian Association of Community Health Centres

 

Scott Wolfe and Grey Showler will be presenting at NWRPCA/CHAMPS 2019 Fall Primary Care Conference 

 

Canadians, by most measures, enjoy good health and quality of life. Our economy is strong, we have an abundance of land and natural resources, we have a robust public education system, and of course, publicly insured health care that covers the majority of healthcare services based on need rather than ability to pay. But beneath the image of a vibrant and healthy country where we take pride in our public systems, the reality is that many Canadians struggle with poverty, mental illness, substance use, precarious housing, food insecurity and a history of trauma from centuries of colonization and other forms of discrimination based on race, culture and other factors. In British Columbia, Canada’s western most province and one of the country’s wealthiest regions, 1 out of 6 children lives in poverty; almost 1500 people died of drug overdose last year; and, homelessness has become endemic. Population level measures like GDP and household income show a prosperous people overall, but even a quick look at the streets of our towns and cities shows that inequality and social exclusion are rife in Canada.

 

The much-celebrated Canadian health care system, while not to blame for these challenges, has done far too little to address the impact of social inequity on health. As currently planned and structured, the publicly funded Canadian system does some things well, like access to trauma care, acute and surgical care, oncology and other specialized services - but has struggled to achieve results in many other aspects. Primary care, for example. Planning and delivery of primary care is largely antiquated across Canada. It is dominated by fee-for-service physician practice, incentivizing volume over quality and rewarding care for healthy patients over complex ones. Our health system typically silos primary care into individual physician practices with long waits for over-utilized specialized services, especially for vulnerable groups like seniors, newcomers and people experiencing moderate to severe mental health and substance use challenges. These primary care services are treatment-focused and detached from health promotion activities and actions to address upstream causes of illness.

 

In addition, several aspects of health care in Canada like dental care, optometry, podiatry, and prescription medications are not publicly insured for all Canadians meaning that those without private insurance or high incomes very often go without these vital services. In this respect, the “system” for these aspects of health care resembles the overall health care system in the United States, with large proportions of the population excluded from access.

 

While the province of British Columbia spends over 40% of its total annual budget on health care, more than 15% percent of British Columbians still do not have a routine primary care provider. Instead, they rely on walk-in clinics where they often see a new provider each visit, with no longitudinal care or access to team based care – which is challenging for most healthy people and nearly impossible for people with complex health and socioeconomic needs.

 

Whereas the U.S. has developed a robust system of CHCs that provide team based primary care for vulnerable populations, Canada has lagged further behind in this respect. So, while Canada has largely resolved the question of public coverage for health care, the U.S. has made greater strides on the question of effective delivery of primary health care -- namely CHCs.

 

By and large, CHCs in Canada are grassroots organizations that are developed from the ground up by communities to the address social inequities and the shortcomings and challenges of “mainstream” primary care identified above. Examples include newcomer-focused CHCs which offer culturally-relevant and linguistically- accessible services; rural CHCs that provide mobile care and outreach to isolated seniors; urban CHCs providing primary care that is integrated with mental health and substance use care (what is known as behavioural health in the U.S.). And, all of them linking team-based primary care to health promotion, community health, and social justice. Most CHCs across Canada are funded from multiple sources including some level of government funding, grants, donations, property tax income, local fundraising, and anything else to keep the lights on. Many of them, certainly in British Columbia, tend to be small with tenuous existences relying on the perseverance and dedication of community members, including leadership of their not-for-profit Boards of Directors.

 

Only in recent years, and in limited parts of the country, have provincial governments and other stakeholders begun to look to CHCs as a necessary solution to help reduce inequities in access to health care and to link primary care services with action on social determinants of health. As of 2019, there are just over 200 CHCs across the entire country with close to 50% located in the province of Ontario which has made the greatest progress in implementing a provincial network of core-funded CHCs.

 

But there are encouraging signs, especially in British Columbia, where the provincial government has committed to expanded funding for existing and new CHCs as part of an overall primary care reform that is introducing team based care and salaried providers to more residents of the province. For the first time in decades, community-governed CHCs are receiving government and media attention, and will most likely be funded by the provincial government at a modest rate of 3 to 5 more CHCs per year into the near future. There are more than 20 CHCs throughout BC currently and increased funding will hopefully support existing and new CHCs to bring appropriate care to more residents of the province, and within our public health care system. BC’s CHCs are working collectively with the British Columbia Association of Community Health Centres (www.bcachc.org) and Canadian Association of Community Health Centres (www.cachc.ca) to achieve collective impact and influence public policy at provincial and national levels.

 

While we can only hope that Canada will one day match the scale and reach of America’s CHCs, we are seeing some of the first steps toward this, grounded in understanding that reforming the way we deliver services within our publicly insured health care system is the unfinished business of our globally-acclaimed system.

 

 

 

 

 

 

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NWRPCA welcomes and regularly publishes white papers and articles submitted by members, partners and associates with subject matter expertise. The appearance of any guest publication in our Health Center News database represents the views of the author and does not constitute endorsement by NWRPCA of the stated opinions or perspectives, nor does it suggest endorsement of the contributor's products or services.


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