Well, maybe I'll identify a few areas in response to your question, which gets at the imponderables of health care policy in the country.
First is the whole issue of those services that are, at this point, provided in the health care systems across the country on a discretionary basis. Whether we're talking about home care or access to drugs or mental health services or palliative care or whatever, I think many people would say these are elements one would expect to be generally available in contemporary health care systems. They are provided to a degree in most provinces and territories, but to a highly variable extent and certainly not at the level one would expect to serve the whole population well. That's one huge area of challenge.
Second, even though we all like to think our health care systems are evolving and adapting, either to demographic change or to technology or whatever, the fact of the matter is that systems don't adapt as readily and as efficiently as they should. Very often there are very good ideas, but it takes a long time for those ideas to roll out across the country. I'll give you an example. In mainstream media in the last few days, you may have seen something about the astonishing overuse of prescription drugs, particularly psychoactive drugs, among elderly Canadians, particularly, but not only, by those individuals who are in nursing homes or other institutional settings. A lot of work has been done to try to make sure that only patients who have been properly diagnosed are actually being administered these drugs.
This is a great initiative and it's going on in some parts of the country. New Brunswick has just announced, for example, that it's going to roll this process out across its entire nursing home system. One could easily ask, if this is a problem everywhere in Canada, which we're led to believe it is, how long will it take to roll out the same protocol across the country. I'm simply saying there are a lot of things we know how to fix, but it takes a long time to roll those fixes out across the country.
Third, partly because of the Canada Health Act, but just for reasons of historical legacy, there's a real focus on hospitals, even though hospitals are consuming a slightly smaller portion of the total health care spending across the country than was the case maybe 20 to 40 years ago. I think we still do not have as much of a focus as we should on delivering care, particularly for people with chronic conditions, to people living in their own homes or in community settings. I think some people would argue that we're still not making investments in the optimal locations.
Fourth is with respect to digital and electronic health records and so on. We've made a lot of progress in the country in terms of digitizing test results and making sure that physicians' offices have access to electronic medical records, but these records often are not interoperable. Somebody can go to a hospital, and certain test results are recorded, and anyone with privileges at that hospital can get access to that information. The same patient goes to their family doctor who has a different system, and someone in that family doctor's office actually receives by mail or fax the results of a test done in a hospital, scans it, and puts it into a record in the physician's office. I think one could say this is a really suboptimal way of operating in 2016.
I could go on with a longer list, but those are four things I would say many people would say we need to tackle.