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Documentary: Health Reform Now

Reference Materials – Health Reform Now

Health Reform Now includes citations from a number of sources in each section. If you would like to review those materials, please see the links below.

Part 1: Background
* 17,032 patients died on waiting lists between April 1, 2022 – March 31, 2023. The report and actual government data responses can be found here
* 931 Ontario patients died in 2022-23 while waiting for heart surgery – click here
* Rise in Ontario deaths while waiting for MRI/CT scans – click here and here
* 2021 Commonwealth Fund report – click here
* Commonwealth Fund wait times – click here
* Fraser Institute 2023 international health care system report – click here
* Canadian Institute for Health Information – government spending data – click here
* Waiting list data – Fraser Institute – click here
* Canada among the highest spenders in the world – click here

Solution – Activity-Based Funding
Activity-based funding is a policy that sees governments fund health facilities each time they provide a service to a patient. This differs from the current standard practice in Canada that sees hospitals provided with an annual cheque each year (referred to as global budgeting).

Activity-based funding incentivizes hospitals to help more patients as it means they receive more funding. They no longer look at patients as people they have to treat, but rather as people they want to treat as it results in more funding.

The sources cited in this section of the documentary include:
* $2 million in losses at the Windsor Hospital’s government-run Tim Hortons – click here
* Montreal Economic Institute reports on activity-based funding – click here and here
* Fraser Institute reports on activity-based funding – click here and here
* Quebec statistics on using activity-based funding (referred to as patient-based funding) – click here (See B.12)

Solution – Partner with Private Clinics
Governments around the world, including in Canada, have shown that it can be more effective to contract non-profit and private health facilities to deliver care to patients,
rather than delivering care through government-run facilities.

* Ontario’s Auditor General report on partnering with private clinics – click here
* Saskatchewan government’s data on partnering with private clinics – click here
* Privately-run Capio St. Goran hospital in Sweden – click here or here for an older report on this facility

Solution – Reimburse for Surgery Abroad
The “Cross Border Directive” allows EU patients to travel to other EU countries for treatment, pay for it, and then receive reimbursement for up to the same cost their
government would have spent to pay for surgery locally.
* SecondStreet.org policy brief on the Cross Border Directive – click here

Solution – Choose to Use Public or Private
No other developed nation on the planet bans patients from choosing private options outside of the public system.

Sweden, France, Australia, the list goes on and on – it is common for developed nations to provide universal public systems and allow non-government options outside of that system. If Canada followed suit, most people would continue to use the public system, but some would choose private options. When this occurs, it would take pressure off the public system.

Sources in this section include:
* 2005 Supreme Court of Canada decision – click here
* Supreme Court refuses to hear challenge seeking to allow patients outside of Quebec to choose between public or private options – click here
* Ontario nurses working in Michigan – click here

Solution – Prevention
If Canadians lived healthier lives, there would be less stress on the health care system in the first place.

To be sure, many Canadians are coping with diseases and health problems that are genetic. But a good portion of provincial health resources are used to assist patients with entirely preventable health problems.

Sources cited in this section include:

* Heart and Stroke Foundation – “almost 80% of premature heart disease and stroke can be prevented through healthy behaviours” – click here
* Canadian Cancer Society – “About 4 in 10 cancer cases can be prevented through healthy living and policies that protect the health of Canadians.” – click here
* Statistics Canada – “According to the World Health Organization, 1 in 10 adults worldwide have diabetes, and most patients (90% to 95% of cases) have type 2 diabetes, which can be prevented (or at least delayed) through behavioural and lifestyle changes.” – click here
* Sweden’s Physical Activity as a Prescription (PAP) program – click here

Conclusion
Sources cited in the conclusion of the documentary include:
* Federal government reducing funds to provinces that allow patients to pay for diagnostic scans – click here
* Ontario governments seeks ban on allowing patients to pay for care at private nurse practitioner clinics – click here
* B.C. government allows drug smoking in hospitals – click here
* B.C. government fights against giving patients choice between using the public system or private options – click here

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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.