Most rural physicians believe that increasing access to private health care is not an answer to improve rural health services, the past-president of the Society of Rural Physicians of Canada told senators last week.
But Dr. Keith MacLellan from the West Quebec town of Shawville also told members of the Senate agriculture committee that the public-private debate is not a major issue in rural health discussions.
“On the issue of private versus public health care systems, in general rural practitioners believe that a private system would make rural health care even less accessible,” he told senators holding hearings on rural poverty.
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“In general, practitioners cannot make a profit in a rural area so a private health care system would lead to even more centralization and urbanization of health care. … Frankly, the issue of private or public is small compared to the problems that people are having just getting any health care at all.”
MacLellan said rural physicians see the impact of rural poverty first hand. And he offered some blunt assessments.
“If you are going to get sick in rural Canada, do not be poor.”
MacLellan said foreign doctors allowed to immigrate on the condition they practise in rural Canada begin almost immediately to plan a move to the city when they can. They also are the core of rural service.
“They have held up rural health care in Canada,” he said. “It has not been our own system that has done it.”
The rural Quebec doctor bemoaned the fact that governments have been presented with evidence of rural health delivery problems, including the 2002 Romanow Commission recommendation that Ottawa target $1.5 billion in spending on rural health.
“This has gone absolutely nowhere.”
In fact, after it issued its first report on how Ottawa could spend most effectively the $1.5 billion, the federal government closed down the Ministerial Advisory Council on Rural Health.
“My view is that it was seen as potentially a problem from a federal-provincial point of view,” he told senators. “The bureaucrats in Health Canada thought that it was better just to let it go.”
While the advisory committee still exists on paper, it has not been convened in almost five years.
MacLellan said Ottawa could help improve rural health delivery by reviving the advisory committee, recognize that the urban medical model of specialization does not serve rural needs, and support local faith or community based groups that work in most rural communities to find appropriate local solutions.
At one point, he showed senators a photo of earth taken from space on a cloudless night. It showed the lights of populated areas and then vast stretches of darkness that represented rural and remote areas.
“The problems for the populations in these dark areas are all the same in terms of health care,” he said. “They are all, in every rural area of the world, older, sicker, poorer and more accident-prone. There also are huge problems in delivering health care to them.”
Conservative senator Len Gustafson, who has represented the southeastern corner of Saskatchewan in Parliament for almost 27 years as an MP and senator, told MacLellan that he is one of those who can afford to get out of town when sick. He does not have faith in the rural health services in his area.
“I know if I get really sick, I want to go to Regina,” said the 73-year-old farmer. “I will not fool around in Weyburn. I want my doctor to say, ‘I do not know what is up here so I want to send you to a specialist.’ I will take my chances and the two or three extra hours to get there. There is just not the expertise (in Weyburn).”
