HALIFAX, N.S. - Canadian seniors are a privileged group. The Conference Board of Canada reports that life expectancy today is 10 years longer than in 1961. And the average Canadian can expect to live three years longer than the average American.
According to 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.
Milbank also reports that in the United States, an increase in primary-care physicians would delay more than 127,000 deaths a year.
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:
• Doctors manage problems sooner, before they become debilitating, life-threatening or chronic;
• Patients get earlier advice on health maintenance and disease prevention;
• Primary-care physicians integrate the advice of many disciplines;
• Primary care helps reduce unnecessary and inappropriate speciality care;
• Primary care increases access to health services for deprived population groups - people with middle or lower incomes.
Unfortunately, many Nova Scotians have impaired access to primary care and no one has bothered to report the harm.
Many Nova Scotians, in urban and rural areas, suffer because they can't find a replacement for doctors who are retiring. An increasing number of Nova Scotians, about 100,000 now, don't 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 (NSHA) approach to primary care increases barriers to primary care. The NSHA insists on deciding who will have primary-care physicians and who will not.
What's surprising is that the Nova Scotia government, as the regulator, doesn't insist that the health authority do its job. Rather, the government has accepted the bizarre premise that Nova Scotians can accept unnecessary suffering and death for a decade, perhaps two more elections, before primary care might work.
Normally, people don't suffer during transition periods. Phone companies didn't cancel landline service while they implemented systems necessary for wireless communication. Retail stores don't ration goods and services as they implement Internet shopping. The ongoing transition to driverless automobiles doesn't prevent you from driving today.
Rationing primary care is harmful. The NSHA and the provincial government should facilitate rather than impede access.
Nova Scotians should not lose the primary-care gains achieved by previous generations.
David Zitner, MD, is a senior fellow with the Atlantic Institute for Market Studies (AIMS.ca).
