SUN NEWS COLUMN: Pursue health reform for the sake of patients

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Kim Purdy experienced a sudden, sharp pain in her hip around Christmas of 2017. Within no time at all, the pain had spread and eventually became so severe that her life was turned upside down.

The once active Albertan now had pain so severe that she could no longer walk her dog and had no choice but to circle parking lots several times in order to find a space close to the door – she simply couldn’t handle walking even moderate distances. Hosting her family’s annual Christmas dinner was another casualty. It was just too strenuous.

In total, Kim spent 14 months living in pain, all the while navigating Alberta’s health care system and waiting for surgery. But she wasn’t alone. Kim told SecondStreet.org:

“When I went to go to some of the classes that they send you to before surgery, I saw all of these poor old people in there in so much agony. You could see it. We’re all just in a line-up waiting for surgery … so nine, eighteen months, two years. I’ve heard worse stories than that even.”

Sadly, as Canada emerges from COVID-19, stories like Kim’s will become even more common. Governments postponed a reported 200,000 health procedures during the pandemic – everything from cancer treatment to elective procedures like hip surgeries.

Canada’s notoriously long waiting lists are becoming even more stressed now that it’s time to find time to reschedule all those postponed procedures.

But what Canadians should note is that it doesn’t have to be this way.

If health care debates could simply mature beyond the ‘our model vs. the U.S. model’ reflex, it would be clear to everyone that many other countries are providing better results than both systems.

The progressive Commonwealth Fund’s exhaustive 2017 report shows that Norway, Australia, the United Kingdom, New Zealand and Netherlands all ranked higher than Canada while spending less as a country on health care.

Australia in particular has an interesting health care model. While all patients are covered under the country’s universal public Medicare system, patients are incentivized to purchase private health insurance.

For example, Australian families earning less than $253,000 CDN a year receive a rebate from the government if they purchase private health benefits (this rebate decreases as incomes rise).

At the same time, a family earning approximately $163,000 CDN each year or more would start to pay a small income tax if they did not purchase private health insurance (this tax ranges from 1-1.5 per cent).

Combined, the rebate and tax incentivize those who can afford to pay for private health insurance to purchase it, taking pressure off the public system.

Over in Europe, Norway’s system is similar to Canada’s, but with a key difference: the Scandinavian country allows both public and private health care options. Unlike in Canada, Norwegians can purchase private health insurance for services such as hip and knee replacements if they do not wish to use the public system.

As of 2016, approximately 10 per cent of Norwegians were enrolled in private health plans – many of which were covered by their employers. As in Australia, private health options help take pressure off the public system.

Make no mistake, no health care system is perfect.

But for the thousands of patients who have painful stories like Kim Purdy’s, don’t our elected officials owe it to them to pursue reform?

Colin Craig is the President of SecondStreet.org and is the author of the new study: COVID-19 Reinforces the need for health reform

This column was published in the June 19, 2020 editions of the Toronto Sun, Ottawa Sun and Winnipeg Sun.

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Prevention – reduce demand in the first place

If Canadians lived healthier lives, we could reduce demand for emergency services, orthopaedic surgeries, primary care and more. 

For instance, if you visit the Canadian Cancer Society’s website, you’ll read that “about four in ten” cancer cases are preventable. The Heart and Stroke Foundation notes that “almost 80 percent of premature heart disease and stroke can be prevented through healthy behaviours.” A similar number of Diabetes cases are also preventable. 

Many joint replacements and visits to ERs and walk-in clinics could also be avoided through healthy living. 

To be sure, not all health problems can be avoided through healthy living – everyday the system treats Canadians with genetic conditions, helps those injured in unavoidable accidents and more.  

But there is an opportunity to reduce pressure on the health care system through Canadians shifting to healthier lifestyles – better diets, more exercise, etc. 

To learn more, watch our Health Reform Now documentary (scroll up) or see this column. 

Partner with non-profits and for-profit clinics

European countries will partner with anyone who can help patients. 

It doesn’t matter if it’s a non-profit, a government entity or a private clinic. What matters is that patients receive quality treatment, in a timely manner and for a competitive price.  

In Canada, governments often delivery services using government-run hospitals instead of seeing if non-profit or private clinics could deliver the services more effectively. 

When governments have partnered with non-profit and private clinics, the results have often been quite good – Saskatchewan, Ontario and British Columbia are just a few examples of where partnerships have worked well. 

Canada should pursue more of these partnerships to reduce wait times and increase the volume of services provided to patients.  

To learn more, watch our Health Reform Now documentary (scroll up) or see the links above. 

Make cross border care more accessible

In Canada, citizens pay high taxes each year and we’re promised universal health care services in return. The problem is, wait times are often extremely long in our health system – sometimes patients have to wait years to see a specialist or receive surgery. 

If patients don’t want to wait long periods, they often have to reach into their own pocket and pay for treatment outside the province or country. 

Throughout the European Union, we also find universal health care systems. But a key difference is that EU patients have the right to go to other EU countries, pay for surgery and then be reimbursed by their home government. Reimbursements cover up to what the patient’s home government would have spent to provide the treatment locally. 

If Canada copied this approach, a patient waiting a year to get their hip operation could instead receive treatment next week in one of thousands of surgical clinics throughout the developed world. 

Governments benefit too as the patient is now back on their feet and avoiding complications that sometimes come with long wait times – meaning the government doesn’t have to treat those complications on top of the initial health problem. 

To learn more, watch our Health Reform Now documentary (scroll up) or this shorter video. 

Legalize access to non-government providers

Canada is the only country in the world that puts up barriers, or outright bans patients from paying for health services locally. 

For instance, a patient in Toronto cannot pay for a hip operation at a private clinic in Toronto. Their only option is to wait for the government to eventually provide treatment or leave the province and pay elsewhere. 

Countries with better-performing universal health care systems do not have such bans. They allow patients a choice – use the public system or pay privately for treatment. Sweden, France, Australia and more – they all allow choice. 

Why? One reason is that allowing choice means some patients will decide to pay privately. This takes pressure off the public system. For instance, in Sweden, 87% of patients use the public system, but 13% purchase private health insurance. 

Ultimately, more choice improves access for patients. 

To learn more, watch our Health Reform Now documentary (scroll up) or watch this short clip on this topic. 

Shift to funding services for patients, not bureaucracies

In Canada, most hospitals receive a cheque from the government each year and are then asked to do their best to help patients. This approach is known as “block funding”. 

Under this model, a patient walking in the door represents a drain on the hospital’s budget. Over the course of a year, hospital administrators have to make sure the budget stretches out so services are rationed. This is why you might have to wait until next year or the year after for a hip operation, knee operation, etc. 

In better-performing universal health systems, they take the opposite approach – hospitals receive money from the government each time they help a patient. If a hospital completes a knee operation, it might receive, say, $10,000. If it completes a knee operation on another patient, it receives another $10,000. 

This model incentivizes hospitals to help more patients – to help more patients with knee operations, cataract surgery, etc. This approach also incentivizes hospitals to spend money on expenses that help patients (e.g. more doctors, nurses, equipment, etc.) rather than using the money on expenses that don’t help patients (e.g. more admin staff). 

To learn more about this policy option, please watch our Health Reform Now documentary (scroll up) or see this post by MEI.