Doctor shortage pushes health costs up, say Queen’s experts

Citing new evidence that a strong relationship with their family doctor can result in fewer trips by Canadians to the emergency department and hospital admissions, two Queen’s researchers are calling on provincial governments to strengthen health-care delivery models that promote continuity of care.

A shortage of family doctors in many parts of the country is contributing to increasing health-care costs, say professors of Family Medicine Walter Rosser and Karen Schultz.

In a paper published on-line today in the Canadian Medical Association Journal (CMAJ) underline the “growing body of evidence” supporting Canadian provincial health insurance plans that strategize ways to build trust in doctor-patient relationships – particularly for seniors and those with chronic diseases.

However, “Shortages of physicians in many parts of the country make continuity of care difficult or impossible for those who do not have a regular physician,” says Dr. Rosser, an emeritus professor and former head of Family Medicine.

A new Canadian study, also released today in the CMAJ, uses Quebec health insurance data to show that having a primary physician and continuity of care is associated with lower emergency department use. “This study makes a significant contribution to the growing body of evidence demonstrating benefits from continuity of care, especially in the elderly,” says Dr. Rosser. The new findings build on recent U.S. studies with similar conclusions.

The Queen’s researchers point out, however, that during the past decade a number of developments in Canada’s health care systems have reduced the possibility for developing strong, trusting relationships between doctors and patients. As well as a shortage of family doctors, other contributing factors include:

· increasing fragmentation of health-care delivery by growth in the number of agencies and organizations delivering health care
· use of specialty clinics for specific problems (e.g. varicose veins and obesity)
· walk-in clinics not connected to family practices

“From a health systems viewpoint, this is very concerning, because those over 65 years old are the heaviest users of the system, and are rapidly growing in numbers,” Dr. Rosser continues, noting that in Ontario, the Family Health Networks and Family Health Team concepts promote improvement in care for patients with chronic diseases as well as the elderly.

“Reducing costs and improving efficiency in health-care delivery to those over 65 has the potential for more cost-effective care,” he says.