How far could community control of health care go? Very far, says John Ginn. Its potential is evident in services to promote the self-management of care, in disease prevention, in emergency rooms, and in long-term residential care. Whether they are delivered by co-ops or private business, for-profit or nonprofit, locally-designed and -managed services are already achieving excellent outcomes.
"Our health care system has arguably the highest level of institutionalized care in the Western world. It is now possible to provide a number of traditionally institutional services in smaller, decentralized community settings. Self-managed care; disease prevention and health promotion; community support; non-traditional approaches to long-term care, mental health and rehabilitative services; early intervention and prevention strategies; virtual health care - these are but a few of the cutting edge possibilities available to those brave enough to embrace them.
"By bringing these services closer to where patients and their families live, work, and play, by delivering them in more personal and tailored settings - whether through co-operatives or private firms, by for-profit or nonprofit means - not only will we see better outcomes, we will see a reduction in burdens now facing the existing system.
"How much ownership over services and outcomes can be assumed at the community level? I don't know. But my experiences on the front lines of health care in Canada tell me the envelope can be pushed a very long way indeed."