Jonathan E. Prousky, MSc, ND1
1Editor, Journal of Orthomolecular Medicine; Chief Naturopathic Medical Officer, Professor, Canadian College of Naturopathic Medicine, 1255 Sheppard Avenue East, North York, Ontario, Canada, M2K 1E2, Tel: 416-498-1255 ext. 235
The Canada Health Act (CHA) is a federal legislative mandate that provides a framework by which all the provinces and territories operate and receive funding for health care services.2 The CHA is guided by five principals – public administration, comprehensiveness, universality, portability, and accessibility. Under the CHA, only certain providers are allowed to render essential or medically necessary care for which they receive remuneration from the province or territory in which they practice. These providers are mainly comprised of primary care physicians, specialists, and dental surgeons.2
As a naturopathic doctor, it has been a challenge practicing a form of medicine not recognized as medically necessary under Canada’s Medicare system. I evaluate patients using the same methods as medical doctors, and I requisition the same laboratory tests when working-up common medical conditions or when ruling out diseases. Under the Canadian Medicare system, the tests that I utilize are considered essential when requisitioned by medical doctors. Because I requisition them, patients need to pay out of pocket for laboratory tests that are normally covered. This duplication of services is an inefficient way to use a resource that is paramount when properly evaluating patients. Some patients will forgo testing with the hope that their medical doctors will authorize these tests. This wastes valuable time since I could have requisitioned these tests, by myself, immediately. Sometimes this adds strain to the patient’s relationship with his/her medical doctor, particularly when there might be a negative viewpoint expressed about the merits of utilizing naturopathic medical services.
In terms of access to the health care system, I feel marginalized because the regulations of the Canadian Medicare system are very restrictive. I cannot refer patients directly to specialists, admit patients to hospitals, prescribe prescription drugs, or use advanced diagnostic procedures and tests. If I had Medicare status, this would enable me to practice more primary care medicine. Patients would also come to view naturopathic doctors as capable primary care providers instead of regarding them as complementary to the conventional medical system.
One of the more remarkable aspects of the Canadian Medicare system is the way in which it is funded. All providers who are part of this system receive remuneration for their services from the government. In addition, the education and training of providers covered within the Canadian Medicare system receive huge subsidies and governmental support. For example, in 2005 the Ontario government announced that four medical schools would receive an additional $33-million to increase the number of family doctors.3
Should naturopathic doctors have status under the Canadian Medicare system? Yes, because insured residents of Canada have tremendous difficulties in finding a family physician, or finding one who is accepting new patients. In 2001, only 24% of family physicians were accepting new patients without restrictions, and 5% reported that their practices were completely closed.4 There are less family physicians since it is commonly perceived as an unappealing specialization during medical school. There are also many family physicians that leave Canada to set up practice in the United States for financial considerations and less government control. Canada was ranked twenty-fourth out of twenty-seven countries in a comparison of age-adjusted doctor-to-patient ratios (2.3 physicians per 1000 people).5 Only the United Kingdom, Japan, and Turkey scored lower than Canada. Overall, there are shortages of physicians in Canada, even when compared to other similarly developed countries and some less developed countries.
At present the federal government is committed to increasing the amount of students entering medical school. There are also more efforts being made into attracting new medical graduates into family medicine. Despite these efforts, there will never be enough graduates of medical schools to meet the health care needs of the Canadian Medicare system. If the federal government wanted to have the best ranking in terms of doctor-to-patient ratios, there would need to be an eighty-one percent increase in the amount of practicing physicians (amounts to an additional 53,663 physicians).5 To relieve physician shortages, the federal government has initiated a fast tracking and expedited certification process of foreign-trained medical doctors.6
An additional option would be the addition of naturopathic doctors to the insured services of the provinces and territories. This would help to offset some of the primary care shortages in Canada, and add a much needed emphasis on health promotion and prevention. When I was practicing as a naturopathic doctor in the State of Washington, I had primary care status with several insurance companies allowing me referral privileges to specialists and co-admitting privileges to hospitals. My scope of practice allowed me to prescribe a limited selection of prescription drugs, and access to advanced imaging and diagnostic tests. Other states have granted naturopathic doctors a very liberal scope of practice and coverage as a primary care physician.
In terms of numbers, adding naturopathic doctors to Canada’s Medicare system would immediately bring in more than 1100 naturopathic doctors delivering primary care services.7 The costs to the Medicare system would increase in the short-term by the addition of naturopathic doctors to the list of insured health care services. While more public insurance coverage would mean more government spending on the remuneration of naturopathic medical services, this would improve upon the current situation by increasing access and choice, and reduce long-term health care costs. Since more patient care would be directed toward health promotion and prevention strategies, the long-term savings would be substantial. Nevertheless, it would take decades before the true economic savings would be realized.
At present, naturopathic doctors continue to offer limited primary care services within Canada’s Medicare system. There is some reason for optimism because new legislation concerning the practice of naturopathic medicine has been passed in two Canadian provinces where naturopathic medicine has been regulated since the 1920s.In British Columbia, new legislative changes will allow naturopathic doctors to practice with a broader scope, authorizing the ability to prescribe a considerable number of prescription drugs.8 In Ontario, new legislative changes will modernize the current practice of naturopathic medicine and increase opportunities for referrals and collaborative care.9 None of these regulatory changers, however, allow for the remuneration of naturopathic services under the current system.
- Storch JL. Country profile: Canada’s health care system. Nurs Ethics 2005;12:414-418.
- Canada Health Act Annual Report 2003-2004. Ottawa, Ontario. Canada Health Act Division, Health Canada. 2004.
- Ontario universities get millions for family doctors. GLOBEANDMAIL.COM. Retrieved November 28, 2005 from: [www.theglobeandmail.com/servlet/story/RTGAM.20051117.wdocs1117/BNStory/National/].
- Fourth annual report highlights advances, opportunities in primary heath care. Canadian Institute for Health Information. Retrieved June 7, 2010 from: [www.cihi.ca/cihiweb/dispPage.jsp?cw_page=media_28may2003_e].
- Esmail N, Walker M. How good is Canadian health care? 2005 report. Vancouver, British Columbia. The Fraser Institute. 2005.
- Federal funding enables more foreign-trained doctors to work in Canada. About Health Canada. Retrieved December 19, 2005 from: [www.hc-sc.gc.ca/ahc-asc/media/nr-cp/2004/2004_08_e.html].
- McKenna A, The Canadian Association of Naturopathic Doctors, Personal Communication, December 19, 2005.
- The Facts About Regulatory Change: NDs will be able to provide enhanced patient care. Retrieved June 7, 2010 from: [www.bcna.ca/].
- A Snapshot of Naturopathic Medicine in Ontario. Retrieved June 7, 2010 from: [www.oand.org/index.php?page=naturopathic-medicine].