The Importance of Receiving the Right Care in the Right Location

The Canadian health care system is incredibly complex, fragmented and multi-layered. It makes more sense to say that there is no one Canadian health care system, but instead multiple health care systems of varying complexity and coverage. Individuals living in large urban centres will have far more resources than individuals living in remote rural areas.  

While society has a general duty to provide equitable health care, in reality, individuals who choose to live in less populated surroundings have to accept that they will most likely not get the health care support that they would receive in a larger setting.  This is one of the costs of living in a non-urban environment. Every choice in life involves trade-offs with different costs and benefits. Where one chooses to live is a deeply personal choice which involves calculated risks about costs, opportunities, and quality of life. One can question the fairness of this, but many individuals who live in the countryside or in small towns would never want to move to the city with its traffic, high housing costs and taxes, and noise and stress. 

While provincial governments, which are responsible for providing health care, should try to provide similar levels of health care services throughout the province, governments face financial and logistic pressures which cannot easily be resolved. The government cannot force doctors, nurses, or other health care professionals to work in certain areas. Local municipalities can try to entice young health care professionals to stay or move to smaller municipalities, but without financial incentives, this is easier said than done.

While acknowledging the limitations of our health care system, it is in the individual’s best interests to receive care closer to home. Long drives to see specialists can be very burdensome, expensive and stressful, especially in winter. If medically feasible, it makes more sense for patients to receive care in their own homes versus having to go to hospitals or clinics. In the case of dialysis, some forms of dialysis can be provided at home. This is an incredibly positive development as it can eliminate expensive, burdensome multiple weekly visits to a dialysis clinic.  While some patients or family members might at first not feel that comfortable using home dialysis, like anything else, with a bit of training and practice, it becomes easier.

It is very important for individuals to take some level of responsibility for their health – as this is incredibly empowering. The goal of health care should be to increase individual autonomy, dignity, and function. Chronic illness can rob us of these important qualities which the healthy take for granted. If an individual can participate in or, even better, direct their care, this can increase his or her sense of autonomy and pride. We all need to continually challenge ourselves to maintain our independence and self-confidence. Training one-self in one’s care should be welcomed as ultimately it is your health and your life.

Receiving care in one’s home or as close to home as possible is a goal worth pursuing, even if it is not always possible. We will never achieve perfect equity of health care services, but it can be improved and is worth working towards.

David Campbell is the ethicist at Kingston Health Sciences

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