Canada must expand public health care or fall further behind
The Commonwealth Fund’s recent report, Mirror, Mirror, ranked Canada’s health care system as ninth among 11 countries. That elicited everything from scathing indictments of Medicare to a quick dismissal of the report itself. The truth, however, lies very much in between.
Mirror, Mirror should act as a wake-up call to policy-makers and health care advocates across the country that without action we will continue to fall behind.
While critics of our public health care system are quick to call its advocates defenders of the status quo, you will be hard pressed to find anyone taking such a position. No doctor wants to see their patients wait for necessary care. No patient wants to wait longer to see a specialist. Public health care advocates across the country are calling for innovative reforms to our health system, investments in our infrastructure, and expansion of coverage into areas like prescription drugs and dental care.
Before throwing out the proverbial baby with the bathwater, it’s important to look at the categories we do poorly in: equity and access.
In these categories, the top performing countries are the UK, the Netherlands, Sweden and Germany (the UK and Netherlands earn top marks in both). Per dollar spent overall on health care, each of these countries spends more on public health care (80-85 percent) than Canada (73 percent), including on a broader range of covered services like dental care and prescription drugs.
It’s an important reminder that Canada’s problem is not too much public funding. It’s not single-payer payment either. In fact, single-payer health systems are administratively efficient and equitable.
It’s that our definition of universality where single-payer applies (hospitals and doctors) is too narrow. We need to update what’s covered in our public system to meet the health needs of Canadians in the 21st Century.
With one in five Canadian families reporting they are unable to fill prescriptions due to cost, it’s no wonder Canada ranks low on equity. The affordability of prescription medications has serious health implications as well. Between 5.5 and 6.5 percent of hospitalizations in Canada are attributed to Canadians inability to take drugs as prescribed.
The situation is eerily similar in dental care. A report from the Canadian Academy of Health Sciences in 2014 found that roughly half of Canadians who lacked access to dental coverage through private insurance avoided going to the dentist at all because of the cost. The Ottawa Board of Health has reported a 52 percent increase in emergency room visits for dental services between 2004 and 2014. In fact, in 2014 there were 1,740 avoidable ER visits for dental services in Ottawa alone.
Wait times and access are also a challenge in any health care system. Though the mechanisms we choose to finance health services are vital, we ignore health care delivery at our peril. While Canadians receive high quality, patient-centered care, many wait too long to access it. The good news is that there are great examples from not just around the world, but also within our own borders of how we can (and are) improving accessibility, equity and quality of care.
For example, in British Columbia, the Mount Saint Joseph Hospital Cataract and Corneal Transplant Unit employed production-line efficiency and shared patient lists to decrease wait times of 12 to 16 weeks to just eight weeks.
Using an interdisciplinary team, advanced practice physiotherapists and centralized intake systems, the Alberta Bone and Joint Institute reduced wait times from 11 months to nine weeks for hip and knee surgery.
An eConsult project built around virtual access to specialists reduced the need for in-person consultations by 40 percent, with specialist advice arriving, on average, in just two days. Piloted in Ottawa, this program is now available across Ontario.
As is often pointed out, we need to do better at spreading and scaling these innovations. Though there is no cookie-cutter approach to this, there are jurisdictions that do this well from whom we can learn. Health care leaders across the country are taking on this challenge.
There is a lot to be proud of in our health care system. But this pride doesn’t preclude a burning desire for improvement and doing better on health care outcomes.
When premiers met at this year’s Council of the Federation, they agreed to push the federal government to open up a dialogue about pharmacare. And when doctors from across the country meet later this month for the Canadian Medical Association General Council, we will discuss innovation and how to continue to work together to improve our health care system.
It is by expanding and enhancing Medicare, not dismantling it, that we will see Canada rise in the ranks among its international partners.
Danyaal Raza is Chair of Canadian Doctors for Medicare, a family physician at St. Michael’s Hospital in Toronto, and Assistant Professor at the University of Toronto.