FINANCIAL POST COLUMN: Heads-up, minister: Canadians are tired of patiently waiting for health care

Federal Health Minister Mark Holland thinks Canadian patients need to be more patient when it comes to health services. Respectfully, minister, time is up. For over 30 years, Canadians have watched political parties of all stripes throw money at the health care system and hope for the best. The results speak for themselves. What Canadians desperately need now is not more patience but health reform.

In his recent press conference, Minister Holland advised Canadians: “I would say to folks, most of the waiting that is occurring is for elective procedures or for procedures that are not an emergency circumstance. That people be patient with those.”

In 1993, according to the Canadian Institute for Health Information, our governments spent $1,688 per person on health care. Last year, spending reached $5,748 per person. That increase is nearly double the rate of inflation. Yet over this same period, Fraser Institute research shows, wait times increased from nine weeks to nearly 28 weeks.

More money, longer wait times. The “throw more money at the system” approach has clearly failed.

Government data show that over 17,000 patients died last year while waiting for surgery or a diagnostic scan. That’s roughly an NHL-sized arena full of patients. The number would be larger except that several health bodies, including most of Quebec’s, simply don’t track this important information. Many of these patients would have spent their final days with cloudy vision or in chronic pain while waiting for cataract surgery or hip operations. For Canada to allow this to happen is simply inhumane.

But the data also show cases where patients died because the government simply took too long to provide surgery. Ontario government data show that since 2013 more than 931 patients have died while waiting for heart surgery — 244 of them after having waited longer than the recommended maximum wait time.

SecondStreet.org spoke with retired nurse Judy Anderson, who shared how she has lost not one but two daughters due to long wait times. Both had treatable heart conditions but were made to wait too long.

During his press conference, Minister Holland suggested Canada has one of the best health care systems in the world, citing an unnamed source that ranked Canada’s system “second best” globally. The minister might want to run that claim by the 85 per cent of Canadians who told Ipsos health care needs “drastic” changes.

Perhaps Holland’s sharpest critique was for the idea of Canadians being allowed to choose between the public system private options — which 63 per cent of us think we should be able to do, according to another recent Ipsos poll. (It was in keeping with a Leger poll commissioned by SecondStreet.org in late 2022 that found 62 per cent favour having private options.)

Minister Holland claims that countries that have systems that allow private options have ended as an “abject failure.” Funny, the rest of the world doesn’t share that view. Sweden, Norway, France, the United Kingdom, Australia, New Zealand — all these countries give patients a choice between using their universal public health care systems or paying for private options. They also score consistently higher in the Commonwealth Fund’s international health care reports than we do.

In fact, no other developed nation has the nonsensical bans on private care that Canada does. Currently, it’s OK for a Calgarian to pay for surgery in Vancouver but not in Calgary and vice versa. These local bans on private payment for medically necessary health services occur everywhere except in Quebec. Why inconvenience patients and increase their costs? Only an ideologue would think this makes sense.

Ultimately, what Canada needs is a system that puts patients — not interest groups and partisans — first. Just as the rest of the developed world has done, Canada needs a more collaborative approach with private health providers, not the demonization we’ve seen from many politicians for the past 30 years.

At the federal level, a good first step would be for Minister Holland to stop spreading misinformation by learning more about what has actually been working well beyond our borders. Patients are tired of being patient.

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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.