Future of health, health care and medicine

CMA Futures Conference

The CMA hosted an invitational conference in February 1999 to explore ways to help medicine to move toward a preferred future. Approximately 170 representatives from the CMA and its divisions, affiliated societies, other health care providers, government and the public delved into what the future has in store for health, health care and medicine. The meeting was another step in the CMA Futures Project, which aims to look ahead 25 years and devise a preferred future to lead the medical profession. [CMA News 1999;9(4):4]

Expanding private health insurance

Arguments supporting the expansion of private health insurance toward either a parallel private stream or an expanded supplementary tier have assumed that insurers are eager to enter the market. Several researchers challenge this. By applying insurance principles to both a parallel and a supplementary tiered system, they concluded that economic incentives will lead private insurers to restrict and cap coverage and that risk selection will increase the cost of a publicly funded plan. When 10 insurers and employers were interviewed they agreed that a parallel private system is incompatible with insurance principles and that supplementary insurance would be restricted to certain people and services. The authors concluded that private insurance represents the wishful thinking of some providers and patients, but no private insurer operating in a competitive market is likely to come running to provide universal, comprehensive and affordable coverage to all wishing to purchase it. [CMAJ 1999;161(5):539-41]

Treating end-stage renal failure in the next millennium

Before the invention of dialysis in the 1940s, the average survival of patients with chronic kidney failure was approximately two weeks. With the current use of dialysis and transplantation, average survival has jumped to about five years. While this is a dramatic achievement, it also has major implications for the health care system as the costs of treating patients with end-stage kidney failure rise with the increased prevalence of the disease.

Researchers examined data from 1981/96 and predicted that the number of Canadians receiving renal replacement therapy will almost double, to 32,952 people, by the end of 2005. In 1996, 17,807 people were receiving such therapy. These projections suggest that Canada will face a growing shortage of resources to accommodate patients with end-stage renal disease. [CMAJ 1999;160(11):1557-63]