TORONTO SUN COLUMN: Governments Should Resolve to Fix Health Care in the New Year

Governments across Canada should all buckle down and stick to one simple New Year’s resolution.

Do something to fix health care.

As we look ahead to 2024, it’s hard to imagine the health crisis not getting worse. The trends are all pointing in the same direction. Fortunately, solutions that could improve the system are well documented.

Last year, waiting list deaths hit a five-year high since SecondStreet.org started tracking this important data – over 17,000 Canadians died waiting for surgery or a diagnostic scan in 2022-23. The Fraser Institute reported that the average wait for surgery has gone up to 27.7 weeks — up from just 9.3 weeks in 1993.

Those are just a couple of signs that the system is failing. It gets worse when you look at everyday Canadians’ stories.

For example, consider Dan Quayle’s story. The 52-year-old Vancouver grandfather was suffering from crippling pain while on a waiting list for chemotherapy. His doctors told him the cancer treatment could give him another year to live. The problem was that they never told him when he would receive the treatment.

So, he suffered and languished on a waiting list. After 10 weeks, he chose the government’s assisted suicide program and is no longer with us.

One can already hear the response from some politicians and activists: “There’s just not enough money in the system!”

Funding is not the problem.

Canada has been pumping money into health care for decades, with no improvement. In 1993, governments spent about $1,700 per person on average — that number jumped to over $5,700 by 2023, according to the Canadian Institute for Health Information.

That’s nearly double what it would take to keep spending on pace with inflation.

It’s clear that throwing money at the problem has not helped. So, what can be done?

There are many ways governments can make meaningful changes. For one, keep the universal system, but give patients the right to pay for care at local private clinics if they choose. Currently, except for Quebec, a series of regulations outlaw patients from paying for surgery at local private clinics.

Every developed country with better health outcomes than Canada does not have such barriers. Sweden, France, Australia and others allow private options as they not only provide patients with more choice, but lead to less pressure on the public system each time patients decide to pay for private care.

Another option is to make traveling for care more accessible. In the European Union, patients have the right to travel to another EU country for care, pay for it, and then be reimbursed for up to what it would have cost to have the procedure done in their home country.

This just makes sense. Patients who choose to travel can access the care they need, while everyone behind them on the waiting list moves up a spot. It’s also basically cost-neutral in the medium term — the government is paying the same amount for the surgery but it’s just doing it earlier. Canadians love this idea. A SecondStreet.org poll shows 74% are in favour of their province copying this policy.

New Year’s resolutions are tough to keep. Everybody knows someone who bought a gym membership on Jan. 2 and has already stopped using it. Still, as we get settled into 2024, it’s more important than ever for governments to resolve the health-care crisis.

Lives are at stake.

Dom Lucyk is the communications director with SecondStreet.org, a Canadian think tank.

This column was originally published in the Sun newspapers on January 19, 2024.

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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.