FINANCIAL POST COLUMN: Canadian health care needs to be more accountable to patients

We need more accountability in health care in Canada. Across the country, Canadians pay big tax bills each year to governments that too often fail to provide quality health care in a timely manner. But not only are services often lacking, governments regularly get away without disclosing serious breaches.

Consider B.C. patient Allison Ducluzeau’s story. In late 2022, she started to feel sharp, persistent abdominal pains. After a visit with her family doctor, a trip to the emergency room and testing, she was diagnosed with late-stage cancer and was told she had anywhere from two months to two years to live. The government refused to provide her with potentially life-saving surgery, which it claimed wouldn’t help. It did, however, suggest assisted suicide as an option.

Ducluzeau couldn’t bear the thought of her children, who are in their 20s, losing their mother at such a young age. After difficult conversations with family members about her situation, she decided to dig a little deeper and not give up. Allison and her family spoke with clinics as far away as Taiwan to find a treatment. Four different health providers told her she was actually a good candidate for surgery — the same surgery the B.C. government refused to provide. Ducluzeau eventually decided on Mercy Medical Center in Baltimore and paid the $200,000 bill out of a small inheritance, by cashing in savings and with funds raised through GoFundMe.

A year and a half later, Ducluzeau is in remission. Not only is she back at work full time, she goes paddle-boarding regularly and has even started running again. She is quite happy she did not take up B.C. health care’s offer of assisted suicide.

What is the B.C. government doing about this debacle? Apparently, nothing. Ducluzeau has sought reimbursement for at least part of her surgical costs, but the government has so far refused. It has been pleased to take thousands of dollars a year from her in taxes all her working life, but is not so keen to pay at least a portion of the bill for its mistake. That should obviously change.

It’s a sad fact that Ducluzeau’s story is far from unique. The same clinic she visited in Baltimore informed SecondStreet.org they have treated many other Canadian patients over the years. One was Lorne Johnson from Ontario, who travelled to the clinic recently because of long wait times at home. Considering that an Ontario court recently ruled that Ontario Health had to cover the cost for an unnamed male patient to travel to Texas to have an artificial vagina added behind his penis, it will be interesting to see if Johnson’s bills for a medically necessary procedure will be covered … but one digresses.

Needless to say, countless other horror stories from Canada’s health-care system don’t get reported on publicly. Data gathered by SecondStreet.org from health bodies nation-wide shows that at least 17,296 patients died in 2022-23 while waiting for a wide array of surgeries and diagnostic scans. How many could have received life-saving treatment had they got faster care? With the exception of Nova Scotia, governments seldom provide a breakdown.

We know about Ducluzeau’s story, not because governments admitted their error, but because she spoke with media about her experience. But media can only cover so many stories and not everyone wants their name splashed across the news. If governments want to improve accountability in the health care sector, they could require health departments to be more upfront when mistakes are made.

Provincial governments often require businesses to file reports when employees receive so much as a bruise during a workplace accident. Often these reports are made public. Why not require governments to disclose, with privacy suitably protected, when patients die waiting for lifesaving treatment, have near misses with death or end up with permanent health problems because of long waits?

Governments are fine setting the transparency bar high for businesses; they should have to meet just as high a bar themselves. And while they’re are at it, they need to be financially accountable when serious breaches are made. In B.C.’s case, they could start by contacting Allison Ducluzeau about her costs.

Colin Craig is the president of the think tank SecondStreet.org.

This column was originally published in The Financial Post on September 10, 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.