The Honourable Justice Michael
Kirby
CANADA’S HEALTH CARE SYSTEM
WEDNESDAY, MAY 16, 2001
The Canadian Chiropractic Association
As President of the Canadian Chiropractic
Association, it is my pleasure to address this committee. The Canadian Chiropractic
Association (The CCA), is a federated association representing the interests of
the chiropractic profession in Canada through the co-operation and co-ordination
of information and programming among its provincial divisions. All 10 provinces
plus the Yukon are represented and through them, The CCA has a membership of approximately
4,500 chiropractors. The association was incorporated in 1953 under the Companies
Act but was active informally for some years previously.
Mission
The mission statement of The CCA is: To help Canadians live healthier lives by informing
the public about the benefits of chiropractic care; promoting the integration of
chiropractic into the health care system; and by facilitating chiropractic research.
History, Education, Licensing
The chiropractic profession has been in existence for approximately 106 years. It
is a regulated health profession recognized by statute in all Canadian provinces
and the Yukon. There are two chiropractic educational institutions in Canada, the
Canadian Memorial Chiropractic College in Toronto, and l’Université du Québec
à Trois-Rivières. Applicants to chiropractic college require 3 years
of university education but 90% have obtained a 4 year undergraduate degree prior
to entering chiropractic college for an additional 4 years of intensive studies.
Following this, all chiropractors must successfully pass both national and provincial
examinations prior to being licensed in the appropriate jurisdiction.
Scope of Practice
Chiropractors deal primarily with neuromusculoskeletal conditions. As primary health
care practitioners, the public may contact them directly without mandatory referral
from another health care professional. The primary goal of chiropractic adjustments
is to treat areas of decreased movement in the spinal and peripheral joints which
can create a reaction in surrounding tissues, that is, ligaments, muscles and nerves,
resulting in pain, dysfunction and muscular spasm. Chiropractors are trained to
prescribe therapeutic exercise and other non-invasive therapies including dietary
counseling. Between 86 and 96 per-cent of all visits to chiropractors are to address
conditions related to headache, neck pain, back pain, and to improve overall function.
As with all regulated health professionals in Canada, chiropractors are required
to obtain informed consent from their patients prior to the delivery of professional
services where a material risk may be involved.
Points of Submission
The CCA supports and applauds the work of the Senate in examining Canada’s health
care system and the challenges facing Canadians in a world radically different from
that which gave rise to the Canada Health Act. We have been asked to comment on
issues related to the existing and foreseeable pressures for change within the health
care system that have the potential to more fully address Canada’s economic burden
of illness and injury issues. We would like to specifically address the following
points in our submission:
- trends impacting on the costs and method of health service delivery and public funding
implications;
- demographics of an ageing general population coupled with strong growth within aboriginal
and special needs populations;
- increasing public expectations about health care in terms of the variety of services
available;
- the impact of research
Trends impacting on the costs and method of health service delivery and public funding
implications
The CCA believes that pressures
on the costs of health service delivery are well known, but have incorrectly resulted
in a crisis of public confidence in the sustainability of Canada’s health care system.
Persistent media reports of spiraling and out of control health care expenditures
fail, in most instances, to note other than superficial causes. We feel that the
underlying cause has resulted from a shift in public funding away from a focus on
patient care and well-being to one of cost containment based on the continuity of
existing methods of health service delivery.
Canadians are entitled to safe
and effective health care options which are accessible, affordable and appropriate.
Many studies have now provided unequivocal evidence as to the effectiveness and
cost-effectiveness of chiropractic care. However, chiropractors have not been utilized
by Canada’s health care system in the most effective way. This has sometimes resulted
from legislative and policy barriers and sometimes from funding decisions made on
a silo basis which result in inequitable resource allocation irrespective of patient
choice, effectiveness, or cost effectiveness. Canadians have been similarly restricted
in obtaining the services of midwives and nurse practitioners.
Recommendations - Efficiency
and Cost–Effectiveness
The CCA recommends:
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a)
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minimizing or eliminating unnecessary
duplication of services;
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b)
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increasing the accuracy and speed
of diagnoses thereby preventing inappropriate treatment, such as ensuring that neuromusculoskeletal
related conditions are referred to chiropractors in the first instance;
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c)
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shifting from institutional based
care to community based care reducing hospitalization;
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d)
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implementing an intrasystem shift
in utilization of providers respective of specific health conditions;
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e)
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investing in health promotion,
maintenance and protection and in disease prevention.
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The current perceived crisis in
health care funding is more accurately characterized as a crisis generated by a
lack of system wide planning, effectiveness and accountability. We believe that
health care funding could be significantly leveraged through a fundamental re-examination
and re-configuration of service delivery methods.
Demographics of an ageing general
population coupled with strong growth within aboriginal and special needs populations
It has been estimated that 20%
of Canadians utilize 80% of health system resources. As Canada’s population ages,
the 20% is growing rapidly and the current system will not be sustainable. Special
needs populations such as HIV/AIDS patients and others who enjoy longer lives resulting
from drug therapy will demand more human resources in terms of the management of
their conditions. This human resources health service delivery deficit will be further
strained through the introduction from offshore locales of diseases previously considered
under control or unknown in Canada. Generally, Canada’s aboriginal populations,
which have long accepted chiropractic as an alternative to their health care needs,
are expected to grow at a faster pace than non-aboriginals resulting in increasing
demands for service delivery in locations where population densities have traditionally
been considered insufficient to support the current system’s infrastructure.
Canadians are becoming concerned
about the future of health care. The traditional delivery methods are no longer
effective or efficient at responding to total health care requirements. While traditional
medicine has enjoyed successes in treating acute illnesses, it has yet to address
any substantive benefit to Canadians in treating or preventing chronic diseases.
There are significant quality of life challenges related to chronicity, disability
and longevity. The delivery of health care must now address those chronic illnesses
and this is where other regulated health professions can ease the pressures on the
current health system. Systemic pressures are reduced by enhancing innovative utilization
of health professions in a health care system which is demanding better service
at lower costs.
Canadians suffering from neuromusculoskeletal
conditions often cannot obtain the services of a chiropractor due to the existence
of barriers which are impractical, unnecessary, and inequitable. For example, chiropractors
do not have hospital privileges, they cannot refer their patients to publicly supported
X-ray facilities or diagnostic laboratories, or render services to their patients
who may require hospitalization. Senior citizens who may have been life long chiropractic
patients are often denied access to chiropractic services should they be institutionalized.
By law, chiropractors are required to refer conditions outside of their scope of
practice to other health professionals in order to ensure patients receive the best
possible treatment. But there is no necessity to refer patients suffering from NMS
conditions to chiropractors who have the best education, training, and experience
to deal with these conditions. As a result, Canadians suffer needlessly and costs
to the public purse mount. Responding to the current and future health needs of
Canadians calls for managing the system as opposed to managing any one profession’s
economic interests.
Recommendations - Demographic
and special needs populations
The CCA recommends:
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a)
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focusing on health promotion and
disease prevention among an ageing population to improve overall health and well
being and to reduce pressures on the current system;
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b)
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funding quality of life health
care interventions among chronic populations by the best qualified practitioners,
for example, chiropractors are well trained and experienced in pain reduction and
nutritional counseling, but patients are often unable to access their services due
to the lack of system integration and patient focus;
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c)
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removing or reducing system restrictions
which prevent aboriginal populations from seeking other than expensively funded
health care services;
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d)
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aligning and managing health care
services on a basis more sensitive to the cultural values of aboriginal and other
identified populations;
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e)
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shifting financial resource allocation
to better address the needs of specialized populations rather than committing more
money to the current system.
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Increasing public expectations
about health care in terms of the variety of services available
It is well known that Canadians
want choices in all aspects of their lives, yet this expectation is not being met
by the current health care system with its emphasis on medicine, hospitals and drugs.
Patients do not want exclusivity of health care management, they want choice. They
want to “mix and match” professional services to the benefit of their individual
circumstances. Patients are also increasingly and beneficially knowledgeable about
their own health conditions and the benefits and risks of the treatments available
to them. Because of this, the demands on traditional services and the time required
to respond to the legitimate health care questions of patients will only increase.
Multiple consultations with different health care professionals and the pressures
to diagnose quickly may lead to an over reliance on drug therapy with its attendant
potential negative ramifications and high costs.
The Senators are well aware of
the research in the area of choice and Canadians are voting with their feet. With
respect to chiropractic, 4.5 million Canadians annually have overcome the barriers
of cost, regulation, and non-referral to find their way to chiropractors’ offices
to seek the treatment they want and need. This represents an increase of 25% over
the past 5 years. Our research shows that new chiropractic patients have often been
in the public system for six months and have not obtained relief from symptoms before
finding their way to a chiropractor. This represents six months of ineffective treatment,
six months of discomfort, six months of unnecessary suffering, and six months of
additional expense to the system. In those provinces where chiropractic is not publicly
supported, this means continuity of a negative situation to the detriment of the
patient, the publicly supported system, and the public purse for as long as the
patient suffers. In chronic cases, this can be indefinitely.
Recommendations - Public
expectations and health service variety
The CCA recommends:
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a)
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promoting the evolution in the
roles played by individual professions to provide flexibility of patient
choice and to reduce pressures
on the current system;
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b)
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realigning public resources to
recognize and support existing but underfunded health care interventions and those
which are culturally sensitive;
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c)
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ensuring that the most appropriate
and cost-effective care is provided to patients based on quality outcome and patient
satisfaction measures as supported by research;
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d)
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broadening definitions under The
Canada Health Act to incorporate chiropractic and other regulated health professions
as “medically necessary” based on quality outcome and patient satisfaction measures
as supported by research.
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The impact of research
Within healthcare, education and
research are the currency by which we provide value to the public. Lacking extensive
knowledge of the complexities of health care, Canadians have a right to expect that
credible and high quality research conducted to the highest international standards
can provide them with objective third party information upon which they can evaluate
decisions about diagnoses, treatments, and health care recommendations. Consumer
confidence must be obtained and maintained upon the demonstrated outcomes of clinical
trials in terms of efficacy, cost-effectiveness, and patient satisfaction.
The chiropractic profession, without
benefit of the deep pockets of third parties such as the pharmaceutical industry
or publicly funded research centres, and with a comparatively small base of practitioners,
has been involved in producing over 30 randomized clinical trials comparing adjustment
to other therapies. There are an additional 14 studies proving cost-effectiveness
and a further 16 studies showing reduction in work time loss. Research conducted
by Professor Pran Manga, a noted health economist at the University of Ottawa, estimates
cost savings to the Ontario government alone of up to $1.25 billion annually through
the greater incorporation of chiropractic services into the public health care system
in that province. Similar studies have been conducted in Saskatchewan and Manitoba
with similar results. As both health care professionals and as Canadian taxpayers,
chiropractors, as well as their patients, continue to be frustrated with the lack
of resolve and action to seriously examine alternatives to the present system when
research demonstrates that it can clearly be assisted without the need for additional
financial resources.
Recommendations - research
The CCA recommends:
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a)
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undertaking econometric research
to examine the cost-effectiveness of the provision of health care services based
upon the elimination of duplication of services;
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b)
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providing health care services
by those practitioners who have the best and most effective demonstrated education,
training, skill, and competency for their areas of expertise and scope of practice;
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c)
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funding treatments and therapies
on the basis of demonstrated positive outcomes;
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d)
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Publicly funding research into
the benefits of preventative health care
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e)
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incorporating into the publicly
funded system those health care interventions identified by research as producing
positive outcomes in patient and condition management.
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The Canadian Chiropractic Association
thanks the Committee for the opportunity to have addressed it.
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