A treatment room in the emergency department at Peter Lougheed hospital in Calgary.Jeff McIntosh/The Canadian Press
Brian Day is a physician, medical director of the Cambie Surgery Centre, and former president of the Canadian Medical Association.
Even the staunchest supporters of the status quo in Canadian health care admit it’s in trouble. Tens of thousands of Canadians are suffering and dying as they wait for care. Our so-called comprehensive system demands payments for such vital services as ambulances, prescription drugs, dentistry, physiotherapy and artificial limbs.
Despite its potential negative impact on our Cambie Surgery Centre in B.C., where we currently treat many Albertans, I support the recent announcement by the Alberta government to allow certain physicians to work in both public and private health care. Canadians are already allowed private care as long as they leave their province. The Alberta move is a sensible first step.
Critics wrongly argue that Quebec’s failure to improve its performance after a 2005 Supreme Court decision shows private options won’t help. In that case, the province’s ban on private health insurance, even for treatments deemed “medically necessary,” was struck down by Canada’s highest court. But Quebec did not conform to the ruling, nor does it allow doctors to simultaneously work in both public and private sectors.
Aside from taking Alberta’s lead, I propose some further changes that will benefit everyone – especially lower-income Canadians, who currently suffer the worst access and health outcomes.
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The annual block (or global) funding method of financing Canadian hospitals must end. Currently, every patient visit represents a cost item and a financial burden. In other OECD countries, hospitals are rewarded as funds follow the patient. Patient-focused funding will incentivize public hospitals to attract patients and embrace newer and better treatments.
Governments have undisclosed statistical information on maximum safe wait times for thousands of conditions. Patients who wait longer risk increased harm or death. “Care guarantees,” mandating treatment within those known benchmarks, are needed. For example, the cost of treating stage-one breast cancer is almost 10 times less than stage-four breast cancer. As patients approach the maximum safe time, we should provide public funding for immediate care, even if that means having patients travel outside their province. Experience worldwide proves it is much cheaper to treat patients quickly.
Our massive bureaucracy draws resources away from patients and must be reduced. Canada does not need 14 ministries of health, or 11 times as many public-health bureaucrats per capita as Germany. In Germany, 90 per cent of patients are publicly funded, and wait times are 18 times lower than here.
A hybrid system allowing supplemental private health insurance and private hospitals should be introduced as an urgent priority. Unlike public hospitals, private centres pay taxes to all three levels of government, providing an added public benefit.
Canada is the only wealthy country in the world that bans comprehensive private health insurance. Countries such as Switzerland and the Netherlands, where all patients access timely care, operate universal systems that rely heavily on private insurance and hospitals. Low-income groups receive government subsidies to purchase that insurance. Canada should similarly fund or subsidize premiums for those who cannot afford them. Quicker care saves tax dollars. The equity and “care for the rich” arguments then become irrelevant.
Claims of a doctor shortage oversimplify the issues with health care
The shortage of doctors and the nursing crisis are government-induced. In the early 1990s, medical-school admissions were cut by at least 10 per cent nationwide and nursing schools were closed. Ontario’s NDP government even offered the University of Toronto up to $10-million annually to cut its intake. Politicians’ bizarre reasoning was that rising health care costs were caused by too many doctors treating patients.
To address today’s shortages, we must expand access to state-run medical and nursing schools, and also allow the development of independent private schools. We should encourage the repatriation of the estimated 3,600-plus Canadians currently attending foreign medical schools.
Nurses should be enticed back to work. Many left the work force because of burnout and an unpleasant workplace. It is front-line staff, and not politicians, who face the frustrations of waiting patients. In Ontario alone, 2,000 nurses commute to the U.S. each day, mostly based on their inability to obtain full-time work at home. More full-time, well-remunerated positions are needed, and we must also recruit qualified immigrant health workers.
Canada should participate in the expanding multibillion-dollar field of “medical tourism” by opening our public hospitals to paying patients after hours. The revenue generated could support and improve our public health care. An estimated two million U.S. citizens travel abroad each year for health care but, despite Canada being one of their biggest trading partners, the status quo prevents them from seeking care here. Another source of lost revenue is the more than 300,000 Canadians who leave each year for care abroad.
To use a sports analogy: if a football or hockey team were one of the top spenders in the league, yet continually floundered near the bottom of the standings in performance, wouldn’t we expect management to learn from what the top teams were doing? We need to apply that logic to health care in Canada.