The implications of the Commission on the Future of Health Care in Canada's (CFHCC) recommendations extend beyond the necessarily limited scope of its report. This article explores the potential role of psychologists in a restructured public health care system that goes beyond hospital and physician care to home care and a revamped primary care system. Public plans would also benefit from the use of psychological alternatives to prescription drug therapies. Such evidence-based extensions to the existing Canadian model would improve both health and medical outcomes. They could also introduce new cost-savings to provincial health plans that are presently under immense financial strain.
Our rejoinder addresses two common themes raised in the responses to our article concerning the potential role of psychological services in the future of public health care in Canada. The first concerns the current system's capacity to evolve beyond the medical-hospital illness model of the 1960s to incorporate psychological treatments aimed at illness prevention and health promotion. This would be more likely if psychologists were to participate directly in primary-care and home-based mental health-care reform. The second theme is the presumed negative role of "politics" rather than scientific evidence in decisions concerning public coverage or subsidy. We argue that democratic decision-making is the proper basis upon which decisions concerning public coverage are made, but it need not be in opposition to evidence-based decision-making. As recommended in the final report of the Commission on the Future of Health Care in Canada, the Health Council of Canada along with applied research institutes can make politicians and policy-makers more aware of the growing body of evidence supporting the efficacy of psychological treatments relative to the alternatives.
Si l'on se fie à tous les sondages d'opinion publique récents, l'appui de la population canadienne aux valeurs et aux structures sous-jacentes du régime d'assurance-maladie demeure extrêmement élevé. Cependant, leur confiance est mise à l'épreuve par des représentations constantes voulant que le paiement et la prestation de services accrus du secteur privé à but lucratif soient introduits afin de garantir la viabilité future du régime d'assurance-maladie. Le public, qui attend impatiemment (sans voir encore) que des réformes productives soient réellement mises en oeuvre dans le système, voit encore sa patience rudement mise à l'épreuve. Tous ces délais minent la confiance du public. Et c'est ainsi que certaines « solutions de rechange » gagnent en popularité. Par conséquent, le débat entourant les soins de santé publics ou privés doit être engagé pleinement et sortir de l'ombre de la politique publique de manière à ce que la population canadienne puisse déterminer l'efficacité et la compatibilité de ces deux visions avec les valeurs de notre société. Les réformes tant attendues depuis trop HONORABLE ROY J. ROMANOW, O.C.
Canadians' support for the underlying values and structures of medicare still remains extremely high, according to all recent public opinion studies. However, their confidence is being tested by the persistent advocacy that increased private-for-profit payment and delivery be introduced in order to guarantee medicare's future sustainability. Patience is further being challenged as the public eagerly awaits (but does not yet sees) productive reforms actually being implemented into the system. Delay erodes public support. Alternative "solutions" gain currency. Thus, the public-private debate must be engaged fully and emerge from the shadows of public policy so that Canadians can determine its efficacy and its compatibility with our society's values. Therefore, the long overdue reforms also need to be advanced.One of the most urgent reforms to medicare should address mental health needs and concerns, which I have described as being "an orphan of medicare." An essential first step would be to construct a basic platform of care and research on issues of mental health. This platform would provide necessary, immediate services for those in need and, at another level, would provide the impetus for further solutions to the wide-ranging needs in this field.Overall, the snail's pace of reforms has caused many Canadians to speculate that the future of medicare is at the crossroads on mental health policies and other issues, like accountability, quality, adequate reporting and health outcomes. The time to act is now.
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