Can we blend Canada's public and private systems?

“As we grapple with the challenges of an aging population, it’s vital we look for innovative ways to deliver health care. It’s a matter of life and death.”—Editorial in the Ottawa Sun, August 16, 2022 This was in response to Ontario data from SecondStreet.org, which found that after two years of delayed treatments and lockdowns, 1,417 persons died waiting for surgery in 2021-22, a 43.7% increase over the pre-pandemic numbers. New Ontario Health Minister Sylvia Jones stated that she was “looking at all options,” but was strongly criticized because this might lead to increased privatization. Subsequently Premier Doug Ford added, “We can’t as a province keep doing the same thing and expecting a different result.” How true. The Canadian health system is in crisis due to inadequate federal funding and a severe shortage of nurses, and in some cases physicians. But in addition, we need to revamp the system to look for efficiencies. Perhaps the answers might come from Europe, Taiwan, or South Korea. Read: We need more privatization to save our crumbling health system Quebec is short 8,000 health workers compared to last summer. As a result, it is partially closing six emergency departments and will reduce services in some neonatal units. Calgary Mayor Jyoti Gondek demanded a meeting with Alberta Health Minister Jason Copping as an urgent care centre in nearby Airdrie is to be closed on weekends for eight weeks due to a lack of doctors. In the past year, more than 50 Alberta ERs had been left without MDs. Across Canada, partial ER closures have been occurring mainly due to a lack of nurses. At least 15 ERs have temporarily closed in B.C., 20 in Ontario, three in New Brunswick, one in P.E.I., and a dozen in rural Newfoundland and Labrador. Residents of Nova Scotia face long waits in the emergency department, and last year, 43,000 left without being seen. Many nurses have burned out from COVID-19. As stressed by Linda Silas, president of the Canadian Federation of Nurses, lack of work-life balance is driving many of them away from full-time positions.Last September, nearly half of Nova Scotia nurses were required to work overtime. In many cases, this was nine extra hours. The demand to work overtime was also a major problem in New Brunswick, Saskatchewan, and B.C. Financial incentives have been poor, especially in Ontario, where annual pay increases are still limited to one per cent by Bill 124 (which should be repealed). With regard to physicians, misguided policy-makers in the early 1990s attempted to control heal costs by cutting the enrolment of new physicians in medical schools (as well as nursing schools) and restricted immigration of health professionals. They considered MDs, nurses, and hospitals to be “cost centres” to be controlled, rather than valuable partners to be engaged. Meanwhile, health bureaucrats proliferated. For example, Germany has twice the population of Canada, yet we have 10 times as many health administrators. Money could be saved by drastically pruning the number of paper-pushers in hospitals and ministries of health, and redirecting the savings into hiring more nurses and other health workers. Many orthopedic and other surgeons are underemployed and cannot find appropriate work in Canada. Some permanently leave for the United States. These redirected funds could provide additional operating room time (possibly in private free-standing facilities) and would shorten wait times for knee and hip replacements and cataract extractions. Consider countries ranked highest for health outcomes and wait times such as Denmark, Austria, France, Germany, Belgium, Taiwan, and South Korea. They all have in common universal healthcare that covers everyone, but also a hybrid public-private system. Read: Is Taiwan next? Thus, we need to look at Europe and East Asia—not the United States—to see what these countries are doing right. Vancouver orthopedic surgeon Dr. Brian Day stated, “Canada is the only country in the world where accessing private health care is outlawed, and where you’re forced onto a state wait-list of harm.” From 1997-2021, the cost of our public health insurance increased by 210.2%. Canada spends more than 11% of its GDP on health care—more than 27 comparable other countries. Yet among OECD countries, we rank 25/26 in acute care beds/1,000 population, 26/28 in MDs, 14/24 in nurses and 21/24 in MRI scanners. The mere mention of “privatization” should no longer be a “third rail” that electrocutes its proponents. In the short-term, regulatory colleges should expedite applications from foreign-trained nurses and physicians who are already in Canada. The Ontario College of Nursing processed only 2,000 applications last year and 4,300 to date this year; sadly 26,000 are still waiting. Ironically, a nurse from Windsor recently applied for a license in Michigan and was approved in only four days! Dr. Brian Day and five patients have been challenging the banning of private insurance, but several weeks ago the B.C. Court of Appeal ruled against them. This will certainly go to the Canadian Supreme Court. One obvious fear of increased privatization is that nurses, MDs, etc. will leave the public system for the private one, leaving the former even more short-staffed. Hence, before any major changes are made, adequate sick benefits and other financial incentives must be provided in the public system immediately to encourage nurses and others to return to the workforce. In Canada, some 30% of health care is already privately funded. However, increasingly, we lack timely access to medical and surgical care. The main issue is not public versus private medicine, but how to pay for health in a system with finite resources and unlimited demand. We must be open-minded, not fear change, and should learn from Europe and East Asia about how to successfully blend public and private systems so as to be more efficient and yet fair to all health professionals and patients. Ottawa physician Dr. Charles S. Shaver was born in Montreal. He is Past-Chair of the Section on General Internal Medicine of the Ontario Medical Association. The views here are his own. Read: New social media guidance for Ontario docs from CPSO

Can we blend Canada's public and private systems?

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