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SUN COLUMN: Postponed Surgeries Have Had Tragic Consequences

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SecondStreet.org asked provincial governments across Canada an important health care question: How many surgeries and procedures did you postpone after COVID-19 emerged

While nine provinces were able to give us an answer, one surprisingly replied that it had no idea.

As many readers will know, shortly after COVID-19 arose in Canada, provincial governments informed the public that they were postponing “non-urgent” procedures. The public was told that important procedures such as heart operations would still proceed, but less urgent procedures such as hip operations would be placed on hold.

Ontario’s Minister of Health indicated this was being done to “preserve capacity”. Alberta’s Chief Medical officer noted something similar – to “redeploy” staff. Across the country we saw similar announcements.

Despite what the public was told, media have broken many tragic stories involving these postponed surgeries.

Alberta patient Jerry Dunham was informed, after six months of waiting, that his pacemaker surgery was postponed due to COVID-19. Two months later, he passed away, leaving behind two young children.

In Ontario, the government conceded that upwards of 35 cardiac patients had died after having their surgeries postponed.

In Quebec, actress Rosine Chouinard-Chauveau passed away after having her surgery postponed. She was just 28 years old.

Stories such as these led SecondStreet.org to reach out to provinces for data.

Nine provinces indicated they had postponed 205,549 surgeries and procedures since COVID emerged. A tenth, Ontario, simply told us they had “no records.” Incredibly, their enormous health bureaucracy had apparently not bothered to estimate the size of their problem and report it to the minister.

Thankfully the Canadian Medical Association Journal has examined Ontario’s situation, estimating there have been 148,364 postponed surgeries in the province.

Including their estimate, postponed surgeries and procedures have affected more than 353,913 patients in Canada. For perspective, that’s roughly half the population of Winnipeg.

Make no mistake, it’s quite easy to critique government decisions to postpone surgeries from the sidelines. We can’t forget that many of these decisions were made back in March when the world was scrambling to understand the severity of the outbreak.

But we can’t forget that governments are at least partially to blame for the predicament. Our health care systems had to “redeploy” staff and resources in part because our state-run health care system has fewer hospital beds and doctors (per capita) than other countries with universal health care.

This problem is not due to a lack of funding. As Dr. Shawn Whatley notes in his book, When Politics Comes Before Patients, “Canada spends more on healthcare than most other countries”.

Canada suffers from both mismanagement and a lack of private options. Countries which outperform Canada – Australia, Norway and New Zealand to name a few – have both universal public health care, but also private options.

For the sake of patients, health care reform should be a top priority once COVID is under control.

In the meantime, we would be well served if governments tracked postponed surgeries and patient suffering half as well as they have COVID statistics. Immediate, independent reviews of such decisions could help determine what went wrong and what went right.

It would be tragic to see more patients suffer the same fate as Jerry Dunham and Rosine Chouinard-Chauveau in the future.

 

Colin Craig is the President of SecondStreet.org, a new Canadian think tank.

This column was published by Sun newspapers on March 11, 2021.

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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.