A commentary by a retired risk manager in the private and public sectors.
An election campaign is no time to discuss policy if one wants an in-depth discussion of what, in many respects, has become a dysfunctional health-care system — not the one that some years ago people were touting as “what defines us as a country,” albeit used to differentiate us from the United States, not to compare us with functioning European and Australian systems.
However, the crisis that the system now faces must be addressed soon by politicians — who seem loath to deal with a deteriorating situation.
The unacceptable alternative is a potential collapse through COVID overload, long waitlists for “elective” surgery, shortage of family physicians, and — more recently — staffing burnout.
Looking at the latest (2017) statistics published by the Organization for Economic Co-operation and Development, one sees that we graduate only about 60 per cent of the OECD average of new doctors, per capita — although, for nurses, somewhat higher than the average.
Reviewing the Commonwealth Fund’s latest (2020) international comparison, we find that Canada ranks, unacceptably, at No. 10 (ahead only of the U.S.) — No. 10 in two critical areas, Equity and Outcomes, No. 9 in Access to Care, No. 7 in Administrative Efficiency and No. 4 in Care Process.
So, why are we where we are now?
• A shortage of staff resulting in burnout during a critical period of pandemic. Canada, clearly, did not plan properly to handle a pandemic — although warned about the likelihood of a pandemic, and experienced from SARS (built-in staffing redundancy is, surely, necessary when job training takes years).
• Long waiting lists for “elective” surgery, despite a Quebec court decision too many years ago that being placed on a waiting list is not provision of health-care.
• Twenty-eight per cent of health-care costs being paid for by voluntary insurance or out-of-pocket, according to the OECD statistics — despite a supposed “universal health-care system.”
• Significant discrepancies in qualification criteria for health-care procedures between provinces — i.e., discrimination based on residence.
• Lack of comprehensive, nationwide, electronic health-care data systems. The various provinces are even developing their own COVID passport, although required for “national” use in interprovincial travel.
This is not what Tommy Douglas and other national health-care pioneers intended. So, how do we get to being ranked in the upper half of the pack by The Commonwealth Fund and OECD?
I do not have the answers but, as a retired risk manager, I think that the following would seem to be required:
• A national health-care responsibility and overall policy. Health care is, constitutionally, a provincial responsibility — but, maybe it is time to rethink this constitutional provision, given the advances in the industry since the 1970s and the ability to now properly co-ordinate and manage a national health-care system with nationally consistent standards.
The revenue transfer program was designed to enable all provinces to provide a similar standard of government services. Health-care is a “government service,” so it should be treated in the same manner. Because of its nature as a national civil right, the federal government surely has a duty to ensure that national standards are met (do we allow provinces to administer discriminatory legislation according to their own peculiar whims?).
• National health-care standards and information systems. Giving provinces the leeway to deny services provided in other provinces makes no sense if we a really a country, not just an aggregate of individual fiefdoms. Provincial IT makes no sense for this industry.
• A national health ministry with enforcement provisions. If we have national standards, then the federal government must develop and enforce them.
Provinces must be held to account for provision of services — withholding transfer payments for other services in the event of failure to meet national standards would appear appropriate. If provinces cannot provide services to a standard because of local factors — wage levels, demographics — then they must deal with the issue and fund over and above the national average; for example, the federal government does not subsidize the cost of living in one province or another.
• A program to improve the numbers of staff, where needed, and build in the necessary redundancies in staffing and equipment/supplies necessary to adequately manage pandemics.
We know that COVID is not the final pandemic and it is likely that it will still be endemic when the next pandemic hits. Canada cannot sit idly by, failing to replace expired equipment, nor failing to ensure that the staffing potential is adequate for service provision.
• Improved transparency in B.C., by making health authority boards elected positions, not ministry appointees, with clear, enforceable, transparency guidelines and reporting.
The question, therefore, is whether politicians have the courage to face their responsibilities to us, the citizens, and provide a real health-care system, properly staffed and without long wait times.