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GLOBAL NEWS COLUMN: Hey voters, do not fear the Saskatchewan MRI

Saskatchewan was recently thrust into the national spotlight as Prime Minister Trudeau threatened to reduce funding to the prairie province over its private MRI policy.

What’s the problem? Why should Canadians care? Why does our nation desperately need a serious debate on health reform? Here are a few facts that voters might find of interest.

To begin, private MRI clinics have operated in Canada since the first one opened in Alberta in 1994. Despite critics claiming the sky would fall once these clinics opened, their dire predictions have yet to come to true.

Many of these clinics operate no differently than private labs in Canada. Just as your doctor may send you to a private lab for blood work, sometimes patients are sent to private MRI clinics for a scan. In both cases, the government still picks up the tab for the service.

Other times patients may decide to pay for a private MRI scan at one of these clinics instead of waiting several months (in some cases more than a year) for the government to provide the scan. Each time this happens, one less patient is removed from a government waiting list, shortening the waiting period for everyone else.

Presently, six provinces have private MRI clinics that sell scans to the public, including the Prime Minister’s home province of Quebec. Why the Prime Minister only threatened Saskatchewan with a funding cut is not clear.

If anything, progressive politicians such as Prime Minister Trudeau should like a unique feature of the Saskatchewan government’s MRI policy: private clinics are required to provide a free scan to someone waiting in the public system every time the clinic sells a scan to patients.

Since 2016, more than 10,000 patients waiting in Saskatchewan’s public system have received free scans from these private MRI clinics. Another 10,000 patients received paid scans. Ultimately this means the public system did not have to pay for these scans or add those patients to its already long waiting lists.

Are we to assume the Prime Minister would have preferred those 20,000 patients be added to government waiting lists? Would you want thousands of additional patients in front of your spot in line?

The Prime Minister’s criticism of Saskatchewan’s policy can likely be chalked up to politics. Progressives have a long history of health scare – fear mongering that their opponents would eliminating public health care all together. In reality, in each of the six provinces that have private MRI clinics, government spending on public health care has never been higher.

The problem is throwing money at the system doesn’t work. Our system has been in trouble for years despite massive increases in spending.

Prior to COVID-19, health care waiting lists had never been longer. During the pandemic, governments postponed thousands of surgeries, diagnostic scans and other medical appointments. Those waiting lists are now even longer.

To make matters worse, pressure on our system will increase substantially in the years ahead as our aging population takes its toll – the oldest of the enormous baby boomer generation starts to hit the magic age of 75 this year. Government data shows the average 75-year-old patient costs the health care system more than three times as much as the average 50-year-old patient.

Compared with other countries, our system is underperforming.

A new study by the progressive Commonwealth Fund evaluated the performance of health care systems in eleven developed nations. Canada ranked tenth. Commonwealth Fund research has also shown that of those eleven countries, Canada has the longest waiting periods to see a specialist and to receive elective surgery. 

Their research also found Canada actually spent more than most of the countries that outperformed our nation. 

One thing countries with better performing universal health care systems do differently is they allow patients to choose between using the public health care system and non-government providers (non-profit or for-profit clinics). This not only provides patients with more choices, non-government providers take pressure off of the public system.

To be sure, we have a lot of good, talented people who are stuck in a system that is both underperforming and unsustainable. Allowing more provide clinics to open up and provide more services to the public won’t solve all our problems, but it is a step in the right direction – just as we have seen in Saskatchewan.

Colin Craig is the President of SecondStreet.org, a new Canadian think-tank based in Calgary.

This column was published by Global News on August 26, 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.