“We just can’t, as a province, keep doing the same thing and expecting a different result.” Ontario Premier Doug Ford, August 12
New Ontario Health Minister, Sylvia Jones stated that she was “looking at all options,” but was strongly criticized because this might lead to increased privatization.
Calgary Mayor Jyoti Gondek demanded a meeting with Health Minister Jason Copping as an urgent care centre in nearby Airdrie is to be closed on weekends for eight weeks due to a lack of doctors. In the past year, over 50 Alberta ERs had been left without MDs. Across Canada, partial ER closures have been occurring mainly due to a lack of nurses. Many have burned out from COVID, and especially in Nova Scotia and New Brunswick due to excessive demands to work overtime. Financial incentives have been poor, especially in Ontario, where annual pay increases are limited to one per cent.
Consider countries ranked highest for health outcomes and wait times such as Denmark, Austria, France, Germany, and Belgium. They all have in common universal healthcare that covers everyone, but also a hybrid public-private system.
We need to look at Europe - not the United States - to see what these countries are doing right. Vancouver orthopedic surgeon Dr. Brian Day stated, “Canada is the only country in the world where accessing private health care is outlawed, and where you’re forced onto a state wait-list of harm.”
Canada spends over 11 per cent of its GDP on health care - more than 27 comparable other countries. Yet among OECD countries, we are 25th of 26 in acute care beds/1000 population, 26th of 28 in MDs, 14th of 24 in nurses and 21st of 24 in MRI scanners. The mere mention of “privatization” should no longer be a “third rail’ that electrocutes its proponents.
The Ontario College of Nursing processed only 2000 applications last year and 4300 to date this year; 26,000 are still waiting. Ironically, a nurse from Windsor recently applied for a licence in Michigan and was approved in only four days.
Foreign-trained MDs are likewise limited. An advocacy group represents over 1200 international medical graduates who have not yet been able to obtain a licence to practice in Canada. Of note is that last October, the Labour Mobility Act now requires Alberta regulatory bodies to review and accept or reject credentials within 20 business days; all provinces should follow this example.
Our Canadian health system is in crisis due to lack of adequate federal funding, a severe shortage of nurses and other health professionals, and the need to revamp the system to look for efficiencies.
Misguided policy-makers in the early 1990s cut medical school enrolment in an attempt to control costs. They considered MDs, nurses, and hospitals to be “cost centres” to be controlled, rather than valuable partners to be engaged. Meanwhile, health bureaucrats proliferated.
Germany has twice the population of Canada, yet we have 10 times as many health administrators. Money could be saved by pruning the bloated number of paper-pushers in hospitals and ministries of health, and redirecting savings into hiring more nurses and other health workers. Many orthopedic and other surgeons are underemployed and the increased money could provide increased OR time (possibly in privately-funded free-standing facilities) to shorten wait times for knee and hip replacements and cataract extractions.
Dr. Brian Day and five patients have been challenging the banning of private insurance, but several weeks ago the BC Court of Appeal ruled against them. This will certainly go to the Canadian Supreme Court.
One obvious fear of increased privatization is that nurses, MDs, etc. will leave the public system for the private one, leaving the former even more short-staffed. Hence, before any major changes are made, adequate sick benefits and other financial incentives must be provided in the public system immediately so as to encourage nurses and other to return to the workforce.
In Canada, some 30% of healthcare is already privately-funded. However, increasingly, we lack timely access to medical and surgical care. The main issue is not public versus private medicine, but how to pay for health in a system with finite resources and unlimited demand.
We must be open-minded, not fear change, and should learn from Europe how to successfully blend public and private systems so as to be more efficient and yet fair to health professionals and patients.
Ottawa physician Dr. Charles S. Shaver was born in Montreal. He is Past-Chair of the Section on General Internal Medicine of the Ontario Medical Association.