Like the Netherlands, Canada is a prosperous Western country with a public health system. Both countries are characterised by high public healthcare costs and an average life expectancy of approximately 80 years. I expected two fairly similar countries with equal values, but that turned out to be quite different.
‘How do you organise healthcare in the Netherlands?’ I was asked this question by a Canadian researcher. I was invited by McGill University to participate as an expert in the Mobilizing Knowledge for Elder Empowerment (M-KEE) Forum in Montreal (Canada). I presented how we organise integrated care in the Netherlands to a mixed audience that included patient representatives, policy makers, and researchers. Together we drew up a policy and research agenda for the future of integrated care in Montreal.
Needs of older Canadians
My visit to Canada taught me that integrated care is also an important issue there. How can we organise care and welfare in such a way that it forms a coherent, seamless set of services that fits the needs of older Canadians? At first, the situations in Canada and the Netherlands appeared to be the same, but I also started to notice a number of differences during the conversations I had with the Canadian experts.
The differences between the 2 countries
Because of the federal system, the 13 provinces and territories have relatively much autonomy to organise their own healthcare system. This sometimes causes major differences. The Canadian experts also indicate that there is still a great deal of emphasis on medical excellence of doctors and hospitals. Although people are proud of the healthcare system, it is also understood that there is still room for improvement. Integrated care appears to be one of those future directions.
Vast country
Another challenge is the country’s enormous size: 35.5 million Canadians occupy a surface area of almost 10 million square kilometres (that is almost 250 times larger than the Netherlands!). Densely populated cities that border the United States (Montreal, Toronto, Vancouver) are interspersed with vast swathes of sparsely populated areas. This presents a great challenge for Canadians living there, to receive the right care and support.
An interesting discussion
In Montreal I talked not only about our healthcare system and decentralisation, but also about neighbourhood teams and citizens’ initiatives. This is usually followed by an interesting discussion: how do you ensure that the two different worlds of health and social care come closer together? And, that bottom-up initiatives are given space to develop without turning into chaos? How do you make finances available from a fragmented financial system? It makes you realise that we are doing well in the Netherlands, but we still have a long way to go.
Exchanging experiences
On the last day of the forum, we jointly determine a policy and research agenda for integrated care. ‘Are you satisfied with the past few days?’ I ask, and the answer is in the affirmative. I hope I was able to make a modest contribution. This experience has made me realise again the value of sharing experiences, good examples and insights. It helps to see the developments in my own country from another perspective.
IFIC in North America
It is therefore a good prospect that the International Foundation for Integrated Care (IFIC), of which Vilans colleague Mirella Minkman is a board member, will hold its first North American Conference on Integrated Care in 2020 (NACIC20). The conference takes place from 5 to 7 October 2020, and is being organised by IFIC Canada in collaboration with the University of Toronto.
