Commentary

Canadian seniors are a privileged group. The Conference Board of Canada reports that life expectancy today is 10 years longer than it was in 1961. The average Canadian can expect to live three years longer than the average American.

According to the prestigious journal, The Milbank Quarterly, people with better access to primary care have better health and live longer on average. Access to primary care seems to reduce at least some of the disparities in health between those who are wealthy and those who have middle or low incomes.

Seniors with access to primary care are less likely to die from heart disease, cancer or stroke. When expecting parents have access to primary care infant mortality is lower, reported health is better, and there are fewer low birth weight babies.

A better supply of primary care doctors means that seniors are more likely to have healthy grandchildren. In the United States, people with better access to general practitioners also have better health outcomes in hospital.

Improved primary care and better access to primary care physicians improves overall health because

(a) Doctors manage problems sooner, before they become debilitating, life threatening or chronic

(b) Patients get earlier advice on health maintenance and disease prevention

(c) Primary care physicians integrate the advice of many disciplines

(d) Primary care helps reduce unnecessary and inappropriate speciality care

(e) Primary care increases access to health services for deprived population groups-people with middle or lower incomes.

The Milbank Quarterly reports that in the United States an increase in primary care physicians would delay over 127,000 deaths per year. Unfortunately, many Nova Scotians suffer from impaired access to primary care and no one has bothered to report the harm.

We know for sure, that many Nova Scotians in urban and rural areas suffer because they cannot find a replacement for doctors who are retiring. An increasing number of Nova Scotians, about 100,000, do not have a family doctor.

Previous planning left Nova Scotia with excellent access to primary care physicians because most communities and physicians were able to recognize community needs and respond to them.

The new Nova Scotia Health Authority approach to primary care increases barriers to primary care. The NSHA, seemingly based in Halifax, insists on deciding who will have primary care physicians and who will not.

What is surprising is that the Nova Scotia government, as the regulator, does not insist that the Health Authority do its job. Rather government has accepted the bizarre premise that Nova Scotians can accept unnecessary suffering and death for a decade[1], perhaps two more elections, before primary care might work.

Normally people do not suffer during transition periods. Phone companies did not cancel landline service while they implemented systems necessary for wireless communication.  Retail stores do not ration goods and services as they implement internet shopping. The ongoing transition to driverless automobiles does not prevent you from driving today.

Rationing primary care is harmful. The Nova Scotia Health Authority and the Provincial government should facilitate rather than impede access. Nova Scotians should not lose the primary care gains achieved by previous generations.