Easy access to care is one of the most critical problems that needs to be addressed in our health systems. This is further exacerbated by the fact that not everyone has a family physician. Access to family physicians is, indeed, also a challenge in itself as up to 25% of provincial populations do not have one. The issue with such a statistic is twofold.
On the one hand, not having a family physician means that upstream defusing of health issues is less likely to happen for a significant portion of the population. Dealing with health issues once they are further along in their development creates more pressure on the system with less promising outcomes for the patient. On the other hand, not having a family physician also means not having easy access to facilitated referrals to other levels of care, if required. So, those who have symptoms pointing towards a health issue and no usual means to access the system end up… in the emergency department (ED), which is partially why it suffers from overcrowding…
Walk-in clinics have also grown in importance and numbers over the past decade in order to ease the pressure on EDs and to help people access primary care swiftly. EDs and walk-in clinics are part of the primary care structure in health systems. They are useful to facilitate access to specialized care to the population but they do not create the same continuity of care as the primary care clinics do. They are meant to be used for a specific issue arising outside of the regular, ongoing primary care that should be provided.
The way access to care is designed in health systems creates at least two significant challenges. One is to manage efficiently the web of referrals to different kinds and levels of medical expertise. The other is to facilitate the entry point to the system, which is access to standard primary care. This is needed to ensure better continuity of care as well as timely access to specialized medical expertise higher up in the levels of care. In a nutshell, better access to care means better care altogether and less pressure on the system stemming from systemic inefficiencies.
Thus, looking into how the levels of care (or hierarchy / tiers) functions helps shed partial light on the “access to care” challenge our health systems face. Primary care access and the web of referrals to other kinds and levels of care are good examples of the complexity underpinning the overarching challenge of providing access to healthcare. There are many more dimensions to the “access to care” dilemma that would be useful to explore in order to get the full picture such as poverty, staffing or geographical remoteness. It would be worth digging deeper into these other dimensions to unearth other leads that may help improve health systems. But these are different stories and good ones for future articles…
In the meantime, may you be well, may you be happy.
B.