VANCOUVER SUN: Kris Sims opinion column

It has been well-reported that thousands of Canadian patients have suffered — not just from COVID-19, but from having unrelated surgeries cancelled because of the pandemic.

In fact, the CovidSurg Collaborative research team recently estimated that 400,000 surgical procedures had been postponed due to COVID-19. Everything from cancer treatments to hip surgeries and visits with specialists have been postponed. This ultimately means the already long waiting lists in Canada will grow even longer.

Canadians should take note of two things about the situation:

First, there are some pretty tragic stories behind the 400,000 figure. It is inhuman to shrug our shoulders at it and consider making even more patients suffer on even longer waiting lists.

Consider John Bright’s experience.

Bright once ran a thriving property maintenance company in Squamish — he actually had more work than he could handle and was looking to expand.

Then, in early 2019, John got injured working on a customer’s attic. After nine months of doctors’ appointments he learned he had an extremely painful form of osteoarthritis and would need a double hip replacement. To make matters worse, John is allergic to conventional painkillers and anti-inflammatory medication, so he is suffering in pain.

“It feels like knives stabbing me in the hips all the time,” he said in an interview. “I’m stuck at home and can’t do anything.”

John’s initial consultation with a surgeon was scheduled for April 2, more than a year after he was first injured. He prepared a budget to keep afloat.

Then COVID-19 hit.

“They called me on April 1 to cancel,” he said. “It was like a bad April Fool’s joke.”

Ineligible for CERB or EI, John was left without an income, and finally shuttered his business for good in June. The local rec centre pool was also closed — the one place where he could exercise without extreme discomfort.

“Hip replacements take four to six months to recover from,” John said. “And the wait for the surgery could take years now.”

The second point to consider is that Canada’s waiting lists were unnecessarily long before COVID hit.

The Commonwealth Fund’s exhaustive 2017 international comparison of health care systems in 11 countries found Canadians were most likely to wait long periods to see a specialist and to receive surgery.

A recent SecondStreet.org report shows that Norway, Australia, the United Kingdom, New Zealand and the Netherlands all ranked higher in the Commonwealth Fund study, yet they spend less as a country on health care than what we do.

What allows these countries to have better outcomes with less money? One answer is clear: choice.

Unlike Canada, the other five countries give patients a choice — use the public health-care system or pay out of pocket at a private facility. Ultimately, this helps reduce stress on the public system.

For example, patients in the United Kingdom are, like Canadians, covered by a publicly funded health-care system, the National Health Service, or NHS. Unlike Canadians, however, people in the U.K. can buy private health insurance coverage for elective treatments at private facilities — something 11 per cent of British citizens choose to do. Those who pay for private health coverage help take pressure off the public system.

Australia has universal health care like Canada and the U.K., but it uses a carrot-and-stick approach to encourage its citizens to buy private insurance. Higher-income Australians, families earning more than C$160,000 per year, pay a small tax if they choose not to buy private insurance, while most people, those earning less than C$253,000, are subsidized with tax rebates if they choose to purchase private insurance.

Many other nations provide better health-care services than what patients receive in Canada. For the sake of patients like John, isn’t it time for our elected officials to pursue health-care reform?

Kris Sims is a contributor for SecondStreet.org and is the B.C. Director for the Canadian Taxpayers Federation.

This column was published by the Vancouver Sun on  September 3, 2020.

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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.