A ‘New Canada Health Agreement’ is needed

Daily media reports portray a bleak picture of our healthcare system: overcrowded hospital ERs and the difficulty accessing a family doctor. The pandemic broke an already fragile system. ERs and existing bed capacity cannot meet the additional demands created by the COVID-influenza-RSV infections. The paucity of active hospital beds puts enormous pressure on all healthcare providers and shortchanges Canadians’ access to timely care. Major hospitals’ ERs across the country are well over 100 per cent capacity, partly because the shortage of long-term care beds backs up the system. Does Canada’s healthcare performance differ from that of other high-income countries? In 2020, the OECD published the ranking of 36 countries for hospital beds/1,000 people. South Korea, Japan and Germany ranked in the top three with 12.65, 12.63 and 7.82 beds/1,000 residents respectively. Canada ranked 29th with 2.55 beds/1,000 residents. Quebec and Ontario lagged behind with 1.87 and 2.20 beds/1000 residents respectively1. The Fraser Institute in 2019 published a report comparing performance of 28 universal health care countries. It concluded that although Canada’s is among the most expensive universal-access health-care systems in the OECD, its performance is modest to poor and generally below that of the average OECD country. Canada has significantly fewer physicians, acute-care beds, and psychiatric beds per capita compared to other OECD countries included in the study. The consequences are sobering. Nurses, some suffering burnout, flee their profession. Physicians, with huge demand for their services, struggle to maintain their job satisfaction so critical for proper care and career sustainability. Read: Dr. Brian Gore: Stop blaming FPs for the woes in primary care This lack of hospital capacity and staff shortages indicate where efforts must be directed by both federal and provincial governments if we are to save Canada’s floundering health-care system.The federal government is demanding the provinces provide verifiable health indicators and outcome data before it will increase its transfer payments, creating a roadblock. The provinces rightly argue that they have the legislative responsibility to set policy, direct, fund and monitor health-care services. This interminable dispute has eroded Canadians' belief that our health-care system is able to provide timely access to quality care. This malignant situation requires solutions now, or Canadians are destined to at best mediocre health-care for the foreseeable future. What's needed, urgently, is a federal-provincial political conclave of policy-makers, professional stakeholders and health ministers to resolutely address these deficiencies. It behooves both levels of government not to end the negotiations until binding agreements are reached. Because we urgently need more bed capacity across the country, a seven to 10 year infrastructure agreement should be reached on a vast program of constructing new hospitals and modernizing existing ones. Provinces would provide the demographic and regional infrastructure requirements, and the federal government the funding. Concurrently, provinces must focus on their strategic needs for long-term and home care, comprehensive integrated health care centres and human resources. These elements should roll out while implementing the infrastructure program. This multi-pronged revival of our health-care delivery system must address: Recruitment through highly promoted job fairs, training incentives, skill-upgrading programs, national licensing and integration of qualified foreign health care providers sidelined by government inertia. Education, with enhanced training models including simulation centres, mentoring, cohesive team models and early introduction to clinical settings. Retention inducements for professionals approaching retirement, improved remuneration, benefits and alternate funding models and tax incentives to continue working. Information technology that flows across interconnected platforms, which is sorely deficient now. Evaluation and oversight committees that assess outcomes and independently monitor the new programs to ensure objectives are achieved. We know from the federal-provincial response to the pandemic with vaccine acquisition, distribution and administration that both levels of government can work together effectively for the health of all Canadians. Let us build on this success with our governments agreeing on a New Canada Health Agreement that would safeguard the future of sustainable health care for all Canadians. Brian Gore is a Montreal family physician, epidemiologist and former director of professional services at Donald Berman Maimonides Geriatric Centre. References: 1. La Presse, 4 juillet, 2022

A ‘New Canada Health Agreement’ is needed

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