Huffpost Canada Living ca


Brian W. Rotenberg Headshot

Medical Want Or Medical Need? Our Healthcare System Hangs In The Balance

Posted: Updated:
Paul Taylor via Getty Images


The truth is, we can't have it all. Both the physicians who deliver care and the patients who receive it need to start considering the concept of limited resources in our publicly funded healthcare system.

One of the main tenets of the Canada Health Act is that medically necessary care should be insured by public funds and that all related hospital or physician care should be paid for by the public system. This is the soul of the cherished notion of "free" healthcare that most Canadians hold so dearly.

But the tricky thing is that the Canada Health Act does not actually define what constitutes "medically necessary care." This is left up to the individual health providers to determine, on a case-by-case basis.

At first glance it might seem easy to distinguish "medically necessary" care from optional care. If a patient is sick, then the treatment needed to fix the problem is intuitively considered necessary -- the idea being that medical needs dictate what will be provided by the public system.

And in some circumstances, determining what is "medically necessary" is easy. Both patients and doctors could likely agree that if you have cancer, it needs medical treatment. If you have fractures from a car accident, they need to be fixed.

Likewise there are many other examples that most of us could agree fall into 'optional' care, such as laser eye surgery to remove the need for glasses or cosmetic facial surgery; these procedures could realistically be seen as wants, not needs, and therefore don't merit public funding.

In between these examples, though, is a wide gray area where distinguishing need from want is not nearly so clear. Is fixing an annoying nasal blockage a need or a want? Is getting arthroscopy for a sore knee a need or a want? How about a patient who wants blood tests that aren't medically indicated, but could help them address some health questions they had?

Non-essential care is by no means limited to patient demand. There also exists a vast array of low-quality or low-impact health interventions initiated by doctors -- and publicly funded. Many of these interventions are not supported by evidence.



The antibiotics you were prescribed for a persistent virus? Unnecessary -- and they won't work anyway.

Tests and treatments like these examples, and others, are not medically necessary on top of being costly to the struggling healthcare system. In fact, unnecessary tests can expose patients to harm because of false-positive rates. The "Choosing Wisely Canada" initiative spearheaded by the Canadian Medical Association is just beginning to explore the massive scope of unnecessary care and the impact it has on patients and the health system.



Doctors need to start openly and directly considering the concept of medical necessity when talking with patients about tests or procedures. Patients, in turn, need to keep in mind that their healthcare is not "free," and that many of their health-related complaints likely represent wants, rather than needs.


Follow HuffPost Canada Blogs on Facebook


Things We Hate About Canadian Health Care
Share this
Current Slide