THE HUB COLUMN: These Simple Questions Reveal Canada’s Desperate Need For Health Reform

Health care SecondStreet.org

A health-care worker at Verdun Hospital in Montreal (photo: Paul Chiasson/The Canadian Press)

Governments of all stripes have spent decades pouring billions and billions of additional tax dollars into our health-care system. Despite this, waiting lists have grown longer and longer.

Even before the pandemic, Fraser Institute research shows waiting lists were a hair away from their all-time highs in Canada.

Far too many patients continue to struggle while they wait for care. Some even die as Canadian glaciers continue to outpace meaningful health reform in our nation.

Perhaps a new approach is needed to help usher along change that could help patients. Imagine if more simple, direct questions were posed to governments about patient suffering and if governments were pressured to actually provide answers.

As a small experiment, try asking your local provincial politician how many patients died in your province over the past decade because they waited too long for surgery?

This would obviously be an important data point to track, wouldn’t it?

At SecondStreet.org, we have been asking that question for a couple of years and have identified nearly 27,000 cases whereby patients died while waiting for surgery, diagnostic scans, or procedures. To be clear, the aforementioned figure appears to be largely comprised of cases whereby patients died while waiting for activities that could have merely improved their quality of life (e.g. a hip operation) rather than a procedure that could have saved it (e.g. a heart operation).

But in many cases, provincial governments simply don’t track the data, and if they do, the data is often incomplete. For example, we received very little data from Quebec and none from Vancouver Coastal Health Region. Further, there also doesn’t seem to be any reporting by governments that specifically look at deaths due to long waiting periods.

In Nova Scotia, the government informed SecondStreet.org that 51 patients died last year while waiting for surgeries that could have potentially saved their lives. In “just over three quarters” of the cases, patients waited longer than the recommended timeframe.

Imagine if every province could provide such data. Researchers could easily compile an annual total on patients dying in Canada because governments took too long to get around to providing surgery —surgery which they ban private clinics from providing. Such a report would certainly get tongues wagging in coffee shops across the nation.

Another question worth asking is how many patients have developed additional health problems over the past decade because they had to wait too long for surgery?

Janet Walker, a retired nurse and adjunct professor, described to SecondStreet.org several cases where this has happened. In one situation, a patient was forced to wait a couple of years for knee surgery. During that time, the patient put more pressure on their good knee as they protected their weak knee. By the time the patient’s surgery occurred, two years of putting additional pressure on their good knee had taken its toll—it now needed surgery as well.

Ask provincial politicians about how often patients considered suicide or developed mental health problems while they waited long periods for surgery? Further, do long waitlists equate to in terms of foregone tax revenue as some patients are unable to work and pay income taxes?

If these questions seem unreasonable, consider the high standards that governments expect private businesses to meet.

In 2019, the Manitoba government shut down the Wood Fired Pizza restaurant in Brandon and disclosed the following reason onlineExtensively remodel[ing] a food handling establishment without first registering.

A remodeling without registering? You don’t say.

That same year, WorkSafeBC, the provincial government’s workers compensation board, posted the following information about a workplace accident: a young worker in the lower mainland was “using stilts while applying drywall mud tripped and fell to the ground. This accident resulted in bruising.”

Bruising?

Meanwhile, we don’t hear a peep out of governments when patients die after being forced to wait too long for surgery.

If Canadians want health reform, try asking more simple questions about patient suffering. The answers will elevate the need for health reform.

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

Article originally published in The Hub.

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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.