If you came here from another country and opened a newspaper, you might well come to the conclusion that Ontario’s health care system is falling apart.
It seems that every day there is a headline about a scandal in one part of the health care system or another. An Auditor General’s report is released criticizing the government for ineffective oversight, or a major newspaper exposes outright venality or just plain old incompetence.
But does the health care system really deserve to always be viewed in such a negative light? I recently prepared a presentation for first year medical students at the University of Toronto on the Ontario health care system. I decided they should know the answers to two questions as they prepare to see patients for the first time ever. First, how is the health care system structured? Second, how does the health care system perform?
My answer to the second question is the reason I’m writing this post. Yes, there is no doubt the health care system fails Canadians in many respects. Access to primary care in the evening and on weekends is poor, not enough doctors in Canada use electronic health records and we fail to provide coordinated care to patients with complex conditions. We need to do better in these and other areas.
But there is also no need to run around like Chicken Little shouting that the sky is falling. Many indicators suggest our health care system performs reasonably well. We spend almost exactly the same on health care as Austria, Denmark and France, which is probably right where we want to be. Considering that we are situated right next to the United States, and have to provide comparable compensation to physicians and nurses, the fact that our spending is much closer to European levels could be viewed as an achievement in its own right. On many of the most important measures – life expectancy, deaths that could be avoided by health care, survival after a diagnosis of breast cancer or a heart attack, we also do quite well.
So why the constant chatter that the health care system is on the verge of collapse? There are several reasons. First, the media has an interest in focusing on crises and bad news. A story that we are doing about the same as European comparator countries might not even make the paper, let alone the front page. Second, those who stand to gain from privatization have an obvious interest in making the claim that the public system is failing miserably. Third, people who work in the system, including not only health care professionals but also managers, academics and consultants, can more clearly make the case for more funding if they claim that the health care system is broken. Fourth, if the health care system is the most important public policy issue to Canadians, then opposition politicians have the most to gain by spending their time and energy focusing on what is not working in health care.
I am neither in the “sky is falling” camp nor in the “status quo is just fine” camp. I feel fortunate to be able to tell my patients who are in the throes of a major medical emergency that they will get the care they need. At the same time, I feel disappointed when I have to tell patients with chronic medical problems that the health care system may not provide them with the high quality care I think they should be getting. I think my patients believe me on both counts. Similarly, I think the general public is not easily fooled. They know that there are problems in health care but that we are not in an acute state of crisis. If we were, people would be marching in the streets.
We need to improve Medicare, but we could do without the Chicken Little rhetoric.