Textes d'opinion

Hospital woes continue to mount – nothing new here

Hospital staffing in Ontario is in crisis – as it is in Alberta, British Columbia, and the rest of Canada. Provinces are responding with what they perceive as solutions: Ontario is fast-tracking foreign trained nurses and Alberta has made interprovincial movement of professionals easier. But while these moves will help reduce the red tape surrounding the practice of health professionals, there are also other solutions to consider.

For starters, capacity issues in Canadian health care aren’t new, nor are they entirely attributable to COVID-19. Canada has had a deficiency for years compared to other OECD countries. For instance, in 2019, the number of doctors in Canada was 2.8 per 1,000 inhabitants, compared to 4.3 in Sweden. With below-OECD average numbers and increasing proportions of Canadians scrambling to find a family doctor, ending medical school quotas is a must.

Next, we should make more efficient use of other existing health care resources, like permitting mixed practice and expanding the participation of private facilities in the provision of care, and also allowing other medical professionals to exercise their full scope of practice.

Delegation of certain procedures to nurse practitioners or pharmacists will free up doctors to treat more complex cases and take on new patients. While this doesn’t necessarily help when provinces are experiencing a simultaneous nursing shortage, there is an ample supply of pharmacists who can take on tasks like prescribing certain medications, ordering and interpreting lab tests, and administering vaccinations. Canada actually has more licensed pharmacists per capita than most OECD countries.

More broadly, additional structural changes are needed to increase the capacity of the health care system. Sweden and the U.K. both underwent liberalization to mixed systems that embrace the value of parallel resources, notably private ones, while also maintaining universality. These two systems, while not perfect, both experienced improved access and quality of care for patients, and both outperform Canada’s system with a similar price tag.

Take for instance the management of hospitals. Does this really need to be a responsibility of the public sector? The expansion of the bureaucratic and administrative components of health care have undoubtedly led to a deterioration in outcomes.

Sweden, on the other hand, allows private entrepreneurs to run hospitals financed by the public health care system that cost the public system less and are more efficient. In addition, a 2021 IPSOS poll showed that 59% of Canadians would be in favour of following this model.

And contrary to popular belief, this isn’t outlawed by the Canada Health Act, so provincial governments have the latitude to act.

Canadian hospitals should also transition away from global budgets. Most high-performing universal health care systems utilize some sort of activity-based funding model to remunerate hospitals. Countries that make widespread use of activity-based financing tend to see an increased number of services performed and reduced wait times. In the U.K., transitioning to activity-based funding resulted in competition between institutions as the money now follows the patient. This increased efficiency and performance, and led to cost savings for hospitals.

We are now at a point where dumping more money into the system is like bailing out a yacht with a bucket that has a hole in the bottom. More money won’t solve the systemic, pervasive, and structural issues that plague Canadian health care.

For instance, Ontario has increased health spending nearly 23% since 2018, and Alberta in 2018 spent more per capita than Sweden or the U.K on health care. In 2021, a majority of Canadians agreed that the rate of increase in health care spending is unsustainable.

While hospital closures and staffing crises are alarming, they are not new, and they are not entirely COVID-related. If our decision-makers don’t start to think bigger and bolder when it comes to reform, we will still be having this same conversation years down the road.

Krystle Wittevrongel est analyste senior en politiques publiques et leader du Projet Alberta à l’IEDM. Elle signe ce texte à titre personnel.

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