Our universal health care system (which is really an illness system) is grounded in the Canada Health Act (CHA). This Act ensures that all Canadians have universally free at point of care access to hospital and doctors’ care for medically necessary services.  The Act does not include home and community care. While each province provides some form of home and community care, the scope of that care is decided by the provinces and varies between them.

The time has come to ask the question: can we have a universal health care system and maintain a publicly funded not-for-profit system without a national Home & Community Care Act? The reality is that if we do not address the home and community care sector in a comprehensive integrated manner, we will have a very difficult time to maintain our current health care system.

Canadians of all ages benefit from home care. Over 60% of our $200 billion health care dollars goes to care for 5% of the population.  Much of these costs are consumed by care that can be better provided in the home.  For example, in most Canadian hospitals, two out of every 10 beds are occupied by patients who do not need and do not want to be in the hospital.  Every day, we the taxpayers spend close to $10 million for care that can be provided for the fraction of that price in the community and in the home – if we have set up a comprehensive integrated home, community and primary health care system.  Most of the many reports addressing health care over the last decade recognize the shortcomings of the current ‘illness’ system. We are running out of time!

The Ontario government, in collaboration with various sectors, is trying to deal with these challenges by improving funding and services within the home care sector.  The premiers across the country are also making efforts to collaborate and bring some pan-Canadian solutions to strengthen both home care and primary health care.  We need to applaud all these efforts, but is it enough?  While these are the first steps in the right direction, we cannot afford to be cautious and risk averse.  We need to be bold and pick up the speed of strengthening home and community care before it is too late.

While we spend the bulk of our $200 billion dollars on 5% of the population, most of those dollars are spent on hospitals, including emergency room visits, diagnostic testing, physicians and drugs.  Much of this care is not guided by best practice guidelines.  Furthermore, we spend less than 5% on home and community care.  We will have  better health and better value for all when we start to reallocate our resources …not for input and illness, not for sometimes unnecessary tests, not for the number of ER visits (rather than care provided by primary health care teams), or not for hospital beds occupied by patients who should be at home.

I wonder if Canadians understand the importance of home and community care services.  The role that nurses, personal support workers and others provide in the home is essential for the survival of our universal health care system.  Introducing a universal Home & Community Care Act would be a step towards a better system, one in which the scale is better balanced between hospital care and home care.

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