Chris Young / The Canadian Press
The COVID-19 pandemic has exacerbated fractures in Canada’s health care structure that should motivate providers and policymakers to seek a stronger model that is not only less expensive but also more equitable, panellists at a recent Canadian Medical Association-sponsored event said Globe and Mail Forum.
The pandemic has highlighted the shortcomings of one of the developed world’s most expensive healthcare systems, said Nadeem Esmail, senior fellow at the Fraser Institute. “We started the pandemic with fewer hospital beds than the vast majority of our peer nations. Although we were spending more, we had fewer doctors per thousand population and less medical technology, and our hospital system became overwhelmed much more quickly, forcing us into more aggressive lockdowns, which had a significant impact on the economy.”
It is estimated that wait times alone cost Canadians $4.1 billion annually in lost time and productivity. And much of that can be eliminated by emulating the strategies of countries like Sweden, Switzerland, Germany and the Netherlands, he suggested. All offer competitive private alternatives to public healthcare, helping to reduce waiting times for electoral processes.
A reset should focus on community-based models capable of connecting with customers and alleviating more serious health issues.
— Cheryl Prescod, executive director of Black Creek Community Health Center
“I think we can all agree that the system that we have is broken,” said CMA President Katharine Smart. “More of the same doesn’t work, so let’s get the right people around the table and take action and not be blocked by our commitment to the status quo.”
A major problem in the Canadian system is that results and accountability are not linked very well to funding, she noted. “So we need to improve our data infrastructure and electronic medical records so we can keep track of how we’re doing. Without data, it is very difficult to determine the quality of service provided and which places are doing well and which are not.”
There are also ways to reduce queues by moving more day surgeries that don’t require all the resources of a hospital to private clinics, “but we have to be careful not to derail this conversation by assuming that what we do.” re looking at is creating a market for healthcare,” she adds. “Often what we think about private care in Canada is an American approach that is not an example of a healthcare system that we want to emulate. But we have examples of private delivery of publicly funded services that work well.”
Healthcare also needs to do more to build trust and confidence among marginalized communities that have been hard hit by COVID-19, said Cheryl Prescod, executive director of Black Creek Community Health Centre. She gave the example of a caregiver who had to work two jobs to support his family and in-laws despite contracting the virus. He ended up transmitting infections to his in-laws, who died.
“There are people whose confidence in the healthcare system has been so eroded that they won’t go to the hospital before things get catastrophic enough to require admission. A reset should focus on community-based models that are able to engage with customers and alleviate more serious health issues.”
Home care should also play a bigger role in an overhauled healthcare system, said Ottawa-based caregiver and attorney Craig Conoley. “I think we are the hidden backbone of healthcare and partnerships between healthcare teams and caregivers have been severed due to COVID visiting restrictions.”
Reshaping the healthcare system requires political will, and politicians must recognize this is a special time, suggested Dante Morra, chief of staff and president of THP Solutions at Trillium Health Partners. “It might not be like the Olympics where everyone is cheering, but there are moments when people can come together. I think we’re at a point where we can agree on what’s not working and what’s working better elsewhere, and that’s a great place to start,” he added. “Step one is asking how best to use our universal dollars, and step two is copying someone better than us. And we need to have tough conversations about choice, because choice matters.”
One example of a more effective solution is pooled care, he said, pointing to a cardiac program at Trillium Health Partners where home caregivers provide follow-up care from the time of the procedure as part of the hospital team. The approach results in a reduction in postoperative hospital stays and a significant reduction in readmission rates. “Patients in the program got better outcomes and fewer infections because they got caught earlier, and it cost a lot less,” he explained.
Technology will continue to play an increasing role in the healthcare of the future, and this offers opportunities for Canadian research and development companies to solve problems and become global winners. “The result could be not only savings and better outcomes, but also significant economic growth,” said Dr. morrah
Ultimately, he believes, “Canada has a bright future ahead of us by copying what others do better and using our talent to solve our problems.”