FINANCIAL POST COLUMN: Health Care Needs Reform More Than Dollars

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By Licia Corbella

Mention medical wait times to just about any Canadian and more than likely they’ll have a story to tell — if not their own then one (or more) from family or friends. Chances are, they’ll also agree that Canada needs health care reform.

My long-time friend Beth waited more than two years for an operation to her left hip. The last year, she admits, was “excruciating.” She had to walk with a cane, couldn’t golf, had trouble getting dressed, couldn’t travel, couldn’t play with or take care of her younger grandkids and basically had a very poor quality of life. “We’ve paid into the health care system our entire lives,” says the 79-year-old Calgary grandmother and when I needed help the system wasn’t there for me.”

Beth was so tired of living in near-constant agony she looked into flying to Toronto, where her son, daughter-in-law and three of her grandkids live, to pay to have her hip replaced at a private clinic, Clearpoint Health Network in the Toronto suburb of Don Mills. The price was $28,000 not including the cost of her flight and accommodations. “I couldn’t stand the pain anymore,” she explained, “even though I didn’t want to be away from home to get care and I didn’t want to spend that kind of money I was desperate.”

The irony is that Clearpoint has a clinic in Calgary but the government won’t allow her to spend her own money in her own province on private health care that would alleviate her pain. Coincidentally, Beth has a friend from Ontario who flew to Calgary to pay to have his hip replaced in Alberta because he too is not allowed to spend his own money on his own health in his own province. It’s absurd.

A variety of laws in Canada prevents patients from using their own funds for medically necessary health care in their respective provinces. The loophole is that you can use your own money to pay for health care in other provinces. All of this inconveniences and even harms patients greatly.

In true Canadian fashion, Quebec is an exception, thanks mostly to a 2005 Supreme Court ruling, Chaoulli v. Quebec, which found the government can’t ban private health care while rationing public care to patients. As then-Chief Justice Beverley McLachlin wrote: “Access to a waiting list is not access to health care” — which you think would be true outside Quebec, too.

My friend Beth is just one of 2.9 million Canadians who languished on a health care wait list according to Freedom of Information responses from provincial governments and territories released to think tank SecondStreet.org. Since some provinces didn’t respond with complete data, SecondStreet.org conservatively estimates that at least 3.7 million — or one in every 10 Canadians — is on a health care waiting list.

Sadly, some patients are even dying while waiting to receive a diagnostic scan or meet with a specialist, never mind getting to the point where they’ve been put on a surgical wait list. According to data also collected by SecondStreet.org, between April 2018 and December 2021 a total of 26,875 patients died while waiting for surgery or other health procedures. Details on these deaths are incomplete but the majority appear to be cases where a patient died waiting for care that could have improved their life (e.g., hip surgery) rather than saved it (e.g., heart surgery). There certainly are cases, though, of critical interventions delayed too long. Beth and I have a friend, Wayne, who passed away from colon cancer while he waited for a colonoscopy.

The good news is that just as Beth prepared to buy airline tickets to Toronto to get her hip replacement out of province, a call came through and she ended up having it done in the public system in Calgary — following a 26-month wait. She’s delighted with the outcome and while she’s still using a cane for stability, she anticipates being able to get rid of her cane in the next couple of months.

According to the Fraser Institute, waiting times between referral from a general practitioner and treatment have steadily increased since 1993, when it began tracking them. They currently stand at about 26 weeks or half a year. COVID made wait times even longer but they have been growing for decades.

In October, SecondStreet.org hired public opinion polling firm Leger to ask Canadians about health care reform. It found that the majority of respondents — almost two-thirds of Canadians — support copying a European Union policy that gives patients the right to reimbursement from their governments for planned surgeries they have to get out of province. A majority also support governments hiring private clinics to provide surgeries for patients in the public system — where the patient would not have to pay out of pocket.

Canadians are ready for health reform. How about our politicians?

Licia Corbella, former editorial page editor at the Calgary Herald, is a contributor with SecondStreet.org.

This column was published in The Financial Post on November 23, 2022.

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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.