TRUE NORTH COLUMN: Will Canada’s health care system be there when you need it?

Across Canada, governments are spending more than ever before on health care. From B.C. to PEI, health care has ballooned to the largest single cost faced by provincial governments. The Canadian Institute for Health Information notes that Canada is already “among the highest spenders” in the world.

Despite record spending, we find a system in crisis across the country. More money won’t solve the woes our system faces, but health reform could certainly help. 

According to data collected from provincial governments and published on SecondStreet.org, there are more than 3 million Canadians currently waiting for surgery, appointments with specialists, or diagnostic scans. 

That’s on top of more than 6 million Canadians who can’t find a family doctor. 

All of this is leading to tragic results.

Since 2018-19, nearly 60,000 Canadians have died on waiting lists before getting the care they need. This figure includes a wide array of health services – everything from MRI scans and hip operations, which could improve a patient’s quality of life, to procedures which could potentially save their life (e.g. a heart operation). Regardless, this total is likely much higher, as it comes from incomplete data – data that is incomplete because governments simply don’t care to track it. 

Additionally, we don’t hear figures about those Canadians who have faced more serious health challenges due to delays in care. Cancers which are far more easily treated when caught early go undetected, or worse yet, grow before necessary screenings take place. Autoimmune diseases, like Multiple Sclerosis, can leave a patient in excruciating pain, unable to live a normal life – sometimes for years – before their disease can be identified and treated. Even trying to get antibiotics for a sinus infection can mean waiting for countless hours in a walk-in clinic, or days to weeks to try and find an appointment if there is access to a family doctor. 

Governments also are not tracking the costs that a lack of access to preventative medicine is putting on the health care system. A 2013 CBC article estimated there were $10,000.00 of extra costs for a patient getting treated who is already in poor health. The Bank of Canada’s inflation calculator increases that number to over $13,000 in 2024 dollars. It would be safe to bet your bottom dollar that those Canadians stuck on waiting lists or unable to find a family doctor are all vulnerable to worsening health before treatment is available. 

So, not only is the lack of access to health care in Canada killing Canadians, but it’s taking billions of dollars away from the rest of the system to treat patients for illness which if caught earlier, would be a fraction of the cost. 

As our population continues to age, more and more people will need to rely on our health care system. And yet, we seem wholly unprepared to even confront the challenges we face today. 

Again, more money isn’t the solution. 

That is not to say health care budgets ought to be cut, but rather, a call to recognize the status quo isn’t getting Canada’s patients the treatment they need, when they need it. 

We have seen some provincial governments begin to explore some necessary reforms. For example, some provinces have granted pharmacists increased authority to prescribe medicines and even provide some treatment for minor illnesses in others. Alberta, Saskatchewan and Ontario are all taking important steps to contract private providers to perform surgeries for patients in the public system to help alleviate wait times for health issues like cataracts and knee replacements, freeing up hospital beds for more critical health needs. 

But these reforms aren’t enough. 

Cities like Vancouver have a significant presence of private health facilities, providing innovative and world-class care. Patients from across Canada will often travel to B.C. to pay for private treatment, but government policies ban Canadians living there the option to pay for these same services.

Oddly enough, a court decision in Ontario recently ruled the provincial government must pay for a person to fly to a private clinic in Austin, TX to have a vagina created behind his penis, and yet, Canadians waiting for cancer care, or critical treatment can’t even access private clinics already in Canada. 

If we simply allowed those Canadians to access those clinics we would create new opportunities for patients to get care when it’s needed, not after months – or years – on a waitlist. It’s an easy answer if the question is about how to get more Canadian patients off waitlists and get them the care they need. 

Harrison Fleming is the Legislative and Policy Director with SecondStreet.org, a Canadian think tank.

This column was originally published in True North on August 17, 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.