REGINA LEADER-POST COLUMN: Saskatchewan People are Ready for a Real Shift in Health Care Delivery

First aid kit with stethoscope and syringe - Canada

Health care has been talked about in the news a lot lately, and with good reason. Patients are suffering and dying on waitlists, hospitals are struggling to care for everyone who comes through their doors, and it’s difficult for many to find a family doctor.

So, what can be done to address Canada’s health care crisis?

A new poll commissioned by SecondStreet.org shows that Canadians are ready for change. People have seen governments throw money at the problem for decades and yet the situation has gotten worse.

We hired polling firm Leger to ask Canadians about several different health care reform ideas: in each case, the majority were in favour, especially in Saskatchewan.

One of the ideas we put forward was to copy a policy from the European Union called the Cross Border Directive.  This policy allows EU patients to travel to another EU country for surgery, pay for it, then be reimbursed by their home country. Reimbursements cover up to the same amount it would have cost a patient’s home country to provide surgery locally.

It’s important to note that this policy is a very low cost measure over the medium term as it simply shifts when the government pays for a surgery. Instead of the government paying, say, $5,000 for a patient to have surgery next year, it reimburses them for up to that amount this year if they decide to travel abroad for surgery.

This idea saw resounding support across the country, with 72 per cent of respondents in favour. It was even stronger in Saskatchewan and Manitoba, at 85 per cent.

It’s clear to see how this policy could help Saskatchewan patients. Take, for example, the story of Sharon Kilkenny, an Emerald Park woman who faced a wait of 93 weeks to receive hip surgery. She struggled with chronic pain for several months before deciding to visit a private clinic in Alberta and pay out of pocket to get the care she needed.

Had the EU policy been in place in Saskatchewan, Sharon would have received financial assistance for her expense — or perhaps it may have covered the total cost. Needless to say, copying the EU policy would give even more patients an opportunity to find pain relief, including those who currently can’t afford to travel for care.

Another popular option in the poll was the idea of keeping our public system, but allowing patients to pay for health services at private clinics if they so choose. This option saw 54 per cent support in the Prairies — another sign that people here are hungry for health reform.

The Moe government has set a goal of tackling the province’s surgical backlog and reducing wait times to a maximum of three months by 2030. Part of the strategy is to hire more private clinics to provide scans and surgeries. This is a good step and received widespread support in Saskatchewan and across the country. A solid 64 per cent of Canadians agreed with this approach.

This commitment is a positive step, but there’s more work to do. The latest numbers from the province show that, as of late June, there were almost 9,000 patients waiting more than a year for surgery.

It’s unacceptable that in such a prosperous province, we have people waiting so long for essential care. Imagine living in pain every day, not being able to move around thanks to a bad hip. Should Saskatchewan be a province where thousands of people can’t go to a Rider game with their family, because it’s too painful to walk around the stadium without their hip replacement? Or how about the thousands waiting for cataract surgery, who deal with blinding pain when they see the sun reflected off the fresh sheet of snow that just blanketed much of the province?

The answer is clear. People are ready for real change, and the numbers back it up.

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

This column appeared in the Regina Leader-Post and Saskatoon Star Phoenix on November 22, 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.