Much like hockey, hospital overcrowding is something that many Canadians continue to discuss with passion and concern, and rightfully so. However, the reality is that more hospital beds are not going to be the panacea that many want, hope and need them to be.
It is true, according to the Organization for Economic Cooperation and Development (OECD), that Canada is an outlier in available acute-bed base. Compared to peer OECD countries, many of which also have universal health care, Canada has 2.5 acute care beds per 1,000 people while most have figures north of 4.5 acute beds per 1,000 people.
But beds per population is not the only driver of capacity or measure of success and stability within a system of care. Given the complexity of hospital crowding, simply adding more hospital beds is not an appropriate course of action. Instead, there are several ways to drive improvements in the national health-care structures.
Public health and social determinants of health investments
The Canadian Public Health Association reminds us that if we continue on our current path, upward of 80 per cent of provincial program spending will be directed to health care by 2030. Much will be spent on largely preventable diseases, reducing the available funds needed for the critically important social determinants of health. The result? Continued greater health inequities across populations, continued preventable diseases that drive higher hospitalization rates and further unnecessary expenditures within the health-care system.
Investments in the “upstream” population health-based services, programs and interventions that focus on disease prevention, health promotion and health protection will result in a decreased demand for, and the utilization of “downstream” acute and hospital-based services.
Long-term care and alternate levels of care adjustments
It is no secret that a significant number of patients within hospital settings do not need to be there, nor do they want to be there. According to a Canadian Institute for Health Information (CIHI) report from 2019-20, across Canada, about 16.7 per cent of patient days were from patients coded as alternate level of care (ALC). More than 3 million days were used by patients waiting in beds for another more appropriate care setting!
While it is true that it is expensive in the short-term to create more of these sub-acute beds, the long-term savings and positive implications for the system of care would likely be significant.
From a financial perspective, moving patient care out of hospitals and into homes, when safe to do so, can drive significant cost savings for health-care systems. Moreover, it removes patients from potentially dangerous hospital stays, thus freeing up beds for those inpatients that truly need those services.
Across Canada, studies continue to demonstrate that the majority of patients that could receive care in their home would prefer to do so rather than going to hospital. Frankly, receiving care in patient homes is something that is here to stay and home care and out-of-hospital structures must be bolstered to handle the current and future demand.
Medically necessary pharmaceutical coverage
As of 2016, 91 per cent of Canadians supported a publicly funded universal pharmacare plan. Remarkably, 90 per cent of the pharmaceuticals that patients use in Canada are actually used and needed in outpatient settings, which means significant out-of-pocket expenditures for patients and families. Unfortunately, nearly one in four Canadians fail to take their medication due to costs. Staggeringly, it is estimated that one in six hospitalizations in Canada could be avoided if routine prescription drugs were prescribed and used more appropriately.
The benefits of a comprehensive pharmaceutical plan for Canadians must not be ignored.
Supports for the socially vulnerable/mental health/addictions
According to CIHI, there are many provincial and territorial initiatives attempting to improve treatments and supports so that socially vulnerable, mental health and addictions patients can remain out of inpatient settings as much as possible. The programs include increasing access to community-based mental health and addictions care; increasing the number of specialized treatment beds for those with addictions; increasing access to mental health professionals for youth in schools and communities; and providing more support for families and caregivers to keep their loved ones at home and safe.
Coming out of the pandemic, the needs of these populations are immense and the services available to them are not nearly robust enough. The discussions on how we reform services to better support these patients and families must be accelerated.
For nearly four decades, our national health-care system, based on the Canada Health Act (CHA), has been focused on medically necessary hospital and physician services as the centre of health-care response. Unfortunately, this outdated Act has contributed to a general reliance on the system that is unrealistic and unsustainable on many levels. With this in mind, perhaps reform starts with addressing what the CHA is all about, and how it must be reconfigured to reflect the current and future needs of Canadians.
If the referenced items above were supported more robustly and were included in the comprehensive basket of insured services for Canadians in some fashion, we would see an overall decreased demand on hospital and physician services, improved patient outcomes and wellbeing, decreased hospital overcrowding and decreased costs across health-care structures.
Throwing more money into a “downstream” hospital-based system of care and more inpatient beds is likely one of the most expensive and inefficient things we can do. It is time to think beyond more beds being the solution to overcrowding, and actually do some things “upstream” that will truly revolutionize the national health-care system, a system that sadly, many have lost pride and trust in.