Everyone should have access to affordable care but universal health coverage does not equal universal access to care. Just look at countries like the UK and Canada where almost everyone is insured but you have to wait for months to see a doctor. On a recent trip to Canada, I spoke to a psychiatrist who told me about seeing a psychotic patient after he was on a waiting list for over 6 months. This patient was suffering from vivid hallucinations and was deemed to be a danger to himself and others after he was thoroughly evaluated.

We all know that a lot of Canadians get their care in the US and are starting to have private options available to them in their own country. A 2005 ruling of the Supreme Court of Canada stating that the Quebec government cannot prevent people from paying for private insurance for healthcare procedures and services covered under the national plan was an important event in acknowledging the deficits of the Canadian system. In making this ruling, the Supreme Court of Canada recognized that “delays in the public health care system are widespread, and that, in some serious cases, patients die as a result of waiting lists for public health care.” This speaks volumes about the inadequacy of universal healthcare systems to provide equal access to all beneficiaries. In fact our own VA system, which provides universal heathcare coverage for all veterans, is tainted with health disparities and unequal access to care. A recent study of health disparities in the VA system found that:

… disparities in the VA exist across a wide range of clinical areas and service types. Disparities appear most prevalent for medication adherence and surgery and other invasive procedures, processes that are likely to be affected by the quantity and quality of patient–provider communication, shared decision making, and patient participation.

So having a strong doctor-patient relationship and patient participation, or accountability, are crucial factors in determining health outcomes. Just because someone has health coverage doesn’t mean that they have guaranteed access to quality care. In today’s over-regulated and abrasive healthcare system, there is no true relationship between doctors and patients. Furthermore, patients are not empowered to take better care of themselves and expect their physicians to do everything for them. These issues are among the primary determinants of health outcomes.

A recent review by Leonard E. Egede and Hayden Bosworth recommends the following strategies for reduction of health disparities:

• Evidence-based health systems interventions to improve the process of care
• Culturally tailored patient-level interventions to enhance self-management, self-efficacy, patient activation and patient empowerment
• Interventions to improve patient–provider communication, build trust, and enhance shared decision-making
• Telemedicine-based interventions to improve health care access and participation for people who reside in rural areas

The above recommendations are commonsensical and can best be accomplished by a concerted effort on behalf of the medical establishment to embrace novel technologies that streamline processes and strengthen the doctor-patient relationship by creating new channels of communication. We need to be progressive and realistic, as opposed to judgmental and paternalistic, when it comes to solving existing disparities in health outcomes and access to care.

Filed under: Health Policy