Consumers are spending more of their incomes on health care, and they are making their own decisions about their treatments. Access to health information and new ways of delivering health services are an important part of this trend. Yet generally, the health care system isn't prepared for the demands of tomorrow's consumers, says Dianne Kelderman. She believes community-based health care models are the way of the future and could be a made-in-Atlantic Canada solution to a looming crisis for governments and society.

If there is one public policy issue on the minds of Canadians today, it's health care. But the debate has centred narrowly around public versus private service delivery and protecting the public system at all costs. At the same time, there is greater understanding and acceptance by the public that "governments don't have all the answers."

An option is community-owned and community-delivered care. Communities can create models that work. People want to be engaged and are willing to look at novel solutions and alternatives for health care delivery and ownership.

Here's what we know to be true: Health care costs are projected to grow at double-digit rates for the foreseeable future. The portion of the population that is "elderly" will rise from historical norms of 2% to 3% to 25% to 30% by 2030 (it's 15% currently). Not only are people living longer but they are also demanding ever more expensive diagnostics and treatments. Chronic health concerns account for about 75% of all health care costs in North America. As the baby boomer demographic hits full stride, this figure is expected to grow. The number of taxpayers who will support each retiree will fall in Canada from 3.6 in 1995 to 1.6 by 2030, while spending on pension and health care as a percentage of GDP will rise from 12.6% to 22.5% in the same period.

With these factors at play, the current model of our health care system is unsustainable. Consider, too, that patient expectations are changing. Let me paint you a picture of today's health care consumers:

• They want to play a more active role in their health care decisions.
• They want better communication with their health care providers.
• They want more convenient access to information and services.

In other words, research tells us that society wants a self-managed, accessible, and personalized health care system, enabled by today's technology.

So how do we get there? First and foremost, we need to change and widen the debate. Change will only come when "the people" demand it. And they are.

In Atlantic Canada we have a long and proud history of community ownership and social entrepreneurism. The co-operative movement, for example, is a model that is built on people first, profit second, and principles. It's built on a philosophy that, collectively, we can meet our own needs. I suggest that the principles of community ownership, control, governance, and engagement do apply to the health care debate and future delivery considerations.

In fact, there has never been a better time for an active community campaign in this area. If we want an effective and efficient health care system in the future, we had better start taking responsibility for it today.

Dianne Kelderman is the president of Atlantic Economics and CEO of the Nova Scotia Co-operative Council. She has been instrumental in the development of innovative economic tools and financing programs across Atlantic Canada. Recently she raised community venture capital for a membership-based, patient-focused web portal (healthconnex.ca) that provides valuable and validated information on a variety of health and wellness topics. This spring, with the launch of a new online health care support clinic that connects patients and their doctors, Canada's first online community-based health care venture will become operational.