Could abandoning a province-led health-care system for an interprovincial one better serve Canadians?
A new report by health and policy professionals says yes, and proposes many other ways Canada’s health-care system can be improved.
“Our system is really starting to fail Canadians,” said Dr. Michael Gardam, chair of HealthCareCAN’s board of directors. “We can’t keep playing the game that we’ve played for decades, which is ‘We need more money and leave us alone, federal government, the provinces will deal with it’.”
The report summarizes health-care solutions discussed at a conference held by C.D. Howe Institute, a nonprofit policy research organization. The institute partnered with HealthCareCAN, an advocacy group for health organizations and hospitals, for the event and the report.
Reform is urgently needed, say experts. Canada is continuously falling further behind other developed countries in quality of health care, said Gardam.
“In the past we could have used Band-Aid or duct tape solutions to try to patch things together and keep going,” said Gardam. “The days for those quick fixes are really largely over.”
13 systems
Currently, health-care workers face barriers if they want to work in provinces other than the ones where they’re licensed. The report argues expanding the health-care sector so it connects between provinces would better pool resources to address gaps in care.
“One of the biggest inefficiencies in the Canadian system is baked right into our Constitution, which is health care is a provincial responsibility,” said Gardam. “And so we don’t have a Canadian health-care system. We have 13 health-care systems in Canada.”
Even Canadians who are trained in Canada have a difficult time working in their own country due to provincial barriers. Many health-care professionals work abroad in countries with equivalent health-care systems, such as Ireland, New Zealand and Australia, said Gardam.
“Why can’t they come home?” he said.
One solution discussed in the report would be to allow doctor and nurse practitioners to start caring for patients from other provinces virtually.
“We could get better [health-care] access for people in rural, remote [areas] or underserved populations,” said Rosalie Wyonch, senior policy analyst at the C.D. Howe Institute.
Push for change
Removing barriers that restrict the sharing of patients’ information could also improve treatment, the report says.
For example, when specialists receive referrals from family doctors, they often don’t have access to the health test upon which the referral was based. The specialist might reorder the test, which “wastes time and resources,” said Wyonch.
More data could also improve efficiency. If there was data on how long patients have to wait to see a specialist, for example, doctors could refer patients to the ones with a shorter wait time.
The lack of health data collection leaves Canadians in the dark on how to navigate the health-care system, said Wyonch. For instance, patients currently do not have any information on health-care sector performance, such as surgical wait times, rates of medical error or wait times at walk-in clinics.
“Without that accountability, it’s hard for [the public] to really push for changes that are meaningful and important to them,” said Wyonch.
Health experts also said Canada’s health-care system could be improved by moving toward a team-based approach, where multiple health-care workers provide different levels of care. Currently, the predominant approach is doctor-centric care, where a physician is responsible for all treatment or referrals.
Provinces are starting to adopt this model. Some allow pharmacists to give medications to patients without a doctor’s prescription, for example.
But other professionals, such as nurse practitioners or physician assistants, could also take the load off doctors by prescribing medication for common ailments, said Gardam.
Not safe to innovate
Preventative health-care could help improve Canada’s health-care system, said Gardam, by reducing cases where patients end up requiring intensive care and long hospital stays.
“If you go to a hospital, it’s a failure of the system,” said Gardam. “We could have possibly prevented that 20 years ago if [the patient] had access to primary care.”
The report does not offer definitive answers to who should deliver preventative health-care. But it offers possibilities: public health campaigns; physicians spending more time with patients; better discussion of lifestyle effects on health, said Wyonch.
Health-care experts agreed that public health-care and private health sectors need to be compatible with one another. But they did not agree on how much the two should merge.
Canada already has a considerable amount of private enterprise within the health-care system, said Gardam. For example, pharmacies and rehab clinics are private practices. However, Ottawa is currently working on a national pharmacare program that will be unveiled March 2024.
The key is to consider where the private sector could be beneficial in alleviating the strain from the public sector, said Gardam.
Canada is drastically behind in developing health research and innovations, said health experts. This is partly due to the fact that no one area in health care is responsible for innovation, and those that do try it face incredible backlash if things go wrong, said Wyonch.
Gardam agrees. “[Y]ou’re not allowed to take risks in Canadian health-care because if you take a risk and it costs more money, you’re going to be publicly skewered for that,” said Gardam. “Health-care CEOs get fired all the time — it’s not a safe place to innovate.”
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