According to the Canadian Institute for Health Information, nationwide health-care spending grew by 13 per cent between 2019 and 2020. That’s three times the growth rate over the preceding four years.
The immediate reason, of course, was the COVID crisis.
But while it’s unlikely we’ll see increases of that order again as the pandemic eases, this may well be the straw that breaks the camel’s back.
Our country’s health-care system has been struggling for years.
In B.C. we have too few family physicians, too few nurses, long waits to see a specialist. Our mental-health services are totally inadequate, as are our home-care programs. Most hospitals are running well above full capacity and staff are strained to breaking point.
Long after the COVID crisis has passed, these problems will continue.
No doubt a funding boost would help, but where is the money to be found? Health care is already the most expensive public service, and the 2019 bailout nearly broke the bank.
Every government in Canada, federal and provincial, borrowed to the hilt to raise the needed cash. This cannot be sustained.
So what is to be done? Economize? But how?
One of the most frequent criticisms directed at government services is that they create needless duplication. And there is some basis for that. Why, for instance, do we have 162 municipalities in B.C., some of them serving only a few hundred residents?
Do we really need 60 school boards, each with a team of senior managers making six-figure salaries?
Both are good questions. And once upon a time we could have asked that of the health-care system.
Before regional health authorities were created in the early 2000s, there were roughly 700 separate and independent health-care agencies in our province.
That wasn’t just wasteful, it inhibited the introduction of new technologies, of better practice models, and of long-term planning.
But we fixed that. There are now just five regional authorities, plus one central authority responsible for such province-wide services as cancer care.
There is no practical opportunity for further consolidation.
Cut the number of hospital beds? But again, we’ve already done that.
Thirty years ago, in 1981, there were 6.9 hospital beds per 1,000 population in Canada. Today there are just 2.5, and B.C. has the second-lowest number.
Cut physician salaries? Family doctors in B.C. already make less than the national average.
There are indeed some specialties where reductions should occur. Ophthalmologists, for example, bill around $870,000 a year on average. That’s three times the average for all physicians, and far beyond reason.
On the other hand, there are only 208 of these specialists in B.C. Halve their salaries and the amount saved would be a drop in the ocean.
It’s true our nursing wage rates and benefits are toward the top end of the national grid, but could any government, much less an NDP government, roll these back?
Rather than piecemeal attempts at economy, a fundamental rethink is needed about how we organize this essential service.
Part of the problem is that we live next door to the most profligate health-care system on the planet. The U.S. spends more than twice as much per capita as we do.
Inevitably, some of that excess spills over into our system and raises the expectations of practitioners.
Nevertheless, the need for change is clear. Canada’s public health-care spending is seven per cent higher, per capita, than Britain’s, 11.5 per cent higher than Australia’s and nearly 40 per cent higher than Italy’s.
But while there are lessons to be learned, carrying them through won’t be easy.
Inevitably there will have to be changes in the way family medicine is organized. That will face resistance.
And hospitals must become a last resort instead of, as happens too often, a first resort.
This means shifting resources away from acute care into long-term care and home care. That, too, will meet resistance.
From a patient perspective, these reforms are a win-win proposition. But it will take enormous and sustained political will to make them happen.
Perhaps the COVID nightmare, and its aftermath, will bring about the necessary resolve.
