Sunday, 7 July 2013
Is Canadian health care policy killing rural Canada?
The first warning was when the Google search on Canadian rural hospitals produced 1992 papers. Perhaps the issue is intuitively more obvious and we need to test some hypotheses.
Regionalization closed a large number of small, supposedly inefficient rural hospitals. The best studied were the Saskatchewan closures of 54 rural facilities back also in 1992. Not surprisingly, health status supposedly increased in the short term. Also not surprisingly, many rural communities said that’s interesting, now can we please reopen our hospital? Why – because hospitals drive a huge component of the economic activity of rural communities where they are located. While individual health may have had certain measures of improvement, communities quickly recognized that their community health was suffering.
Did anybody care? Not really, quality and health outcomes improved in the short term, and overall dollars were saved in eliminating supposedly inefficiencies.
For decades, the proportion of physicians practising in rural areas has been only a third to a half of that expected when compared with urban Canada. Staffing rural facilities is often a constant effort of training, recruitment and then departure for bigger cities.
As one bureaucrat once said, the best economic policy is to let rural Canada die. Efficiency is gained through economies of scale only achieved in urban settings. Scary given their ability to affect political policy in the country. The consequence is the migrant movement of youth and young families into larger urban settings, curtailing the community future. It should not be surprising that areas of Canada with proportions of seniors exceeding 20% aggregate around rural areas.
So, DrPHealth is looking for examples of newly opened rural hospitals? Or even rebuilt facilities on the order of what many health regions have accomplished with their flagship hospitals. Where have health regions actively planned to encourage rural growth by implementing expanded health care facilities. (email to firstname.lastname@example.org)
Experience, without supporting data, would suggest that where even the slightest gains are made, they are in semi-urban settings (10-50K populations), only after massive public and political leveraging, and without growth in the form of intervention services like in-patients, obstetrics and surgery. Perhaps this is "good" clinical practice, and there is ample evidence that outcomes in rural settings have perhaps not been as good as urban.
There is also ample evidence that rural populations have reduced access to health care, seek treatment later in illness, tend to have poorer outcomes and a whole list of measures suggestive of an inequity that deserves more attention. Rather than treating rural health as an question of inefficiency, it is time to view it from the lens of equity.
And, what about the slow death knell placed on rural communities through loss of their autonomous health structures? Perhaps a gain in short term efficiency as rural Canada is only about 20% of the population.
Yet birth rates are much higher than urban settings, family sizes tend to be larger, and rural life provides opportunities for future growth and development that would be logical investments to support the whole of the Canadian economy rather than the constrained and razor thin margins that large urban settings now offer.
Perhaps regionalization has padded the wallets of the majority who live in the big cities, but it may well be cutting off our future by not planning to build a sustainable Canadian infrastructure through maximizing the potential of our country.
Its time that more than just a few lone voices like the Society for Rural Physicians of Canada http://www.srpc.ca/ speak out for supporting rural health care. This is an issue that is about Canada’s future and the health of our country.