We need to reset Canadian health care
Extended lockdowns eight months into the COVID-19 crisis remind us there is a large gap between, on the one hand, what Canadians expect from their governments and health-care systems and, on the other, how these institutions have performed in the face of the pandemic.
Front-line workers in health care and elsewhere richly deserve the praise and thanks they have so widely received. Still, the pandemic’s effects on the economy and on the mental and physical health of Canadians could have been greatly reduced, maybe even avoided altogether, if our health-care system were more efficient. After all, it was largely to protect the system that lockdowns and other restrictive measures were put in place.
Canadian health care has been hard-pressed to withstand the repeated blows of the pandemic. One issue highlighted by the crisis is the urgent need for more hospital beds: Canada lags behind many other countries in this regard. We have one-fifth as many hospital beds per capita as Japan. We have around 2.5 per 1,000 inhabitants. France has six, Germany eight. That we don’t have enough hospital beds in a crisis should not be especially surprising: even in normal times, our occupancy rate is far above the international average.
It’s high time to do what’s required to address this situation. The problems stemming from the lack of beds reverberate throughout health care. Access to mental health services and to many surgical procedures has been severely compromised, which should be unacceptable. Despite consistently high spending over the years, the capacity of our health-care system remains mediocre. It seems simply unable to mobilize itself in order to respond to big increases in demand.
There are a number of reasons for this: inflexible “global” budget techniques; Kafkaesque administrative inflexibility; restrictive licensing of health professionals and rigid regulations about what different people can and cannot do; and, finally, the near-prohibition of private care. All these factors have long starved the system, not just of baseline capacity to treat Canadians quickly in normal times, but also and especially of the ability to quickly expand capacity during a serious crisis. These failings put us on a knife’s edge when the pandemic did finally strike.
The good news is that there are solutions. Better yet, they are well-known. For example, we can use “activity-based” funding of hospitals, which, unlike a model based on historical budgets, encourages the provision of care and treatment of more patients.
We can decentralize and de-bureaucratize the health-care system in order to give administrators the tools they need to allocate resources and personnel more effectively. Making full use of existing resources by expanding the scope of practice of nurse-practitioners and pharmacists could also lead to substantial savings. After all, they cost less than doctors. Encouraging telemedicine, which the pandemic exposed many of us to for the first time, is another promising avenue.
Finally, allowing private entrepreneurs to provide health-care services covered by Medicare, an approach used in Europe, would allow us to increase the system’s capacity almost overnight.
Whatever the Canadian health establishment may think of such measures, they have the strong support of Canadians. An Ipsos poll carried out in November on behalf of the Montreal Economic Institute found that 61 per cent of Canadians believe their health system is too bureaucratic to respond to the public’s needs, while 63 per cent are fine with entrepreneurs providing health care within the universal system. As for telemedicine, nearly seven in 10 Canadians want to continue to have access to it after the pandemic is over.
The COVID-19 crisis has intensified the feeling that we should expect far more from our federal and provincial governments, especially with regard to reforms that can introduce more innovation, flexibility and accountability into the provision of health care. Canadians should be able to count on timely treatment in normal times but also be confident their health-care systems will respond when we need them most. This way, policy-makers are not left considering drastic measures when smart preparation could have saved lives.
Peter St. Onge est chercheur associé senior à l’IEDM et l’auteur de « Pour un système de santé fort et résilient après la pandémie – Réformes pour augmenter la capacité d’appoint ». Il signe ce texte à titre personnel.