In July, the Premiers demanded more healthcare money from the feds. At the meetings, the feds defended their healthcare spending priorities and did not put any more money on the table.
André Picard, a respected health care columnist with The Globe and Mail wrote a column about this ongoing debate (as did this writer) in mid-July. Picard essentially said that citizens don’t really care who pays for our national healthcare system.
We sometimes forget that all the money comes from citizens anyway. In 2019/2020, the federal government collected $167.6 billion in personal income tax alone. During 2020, Canada ranked sixth in the world for per capita healthcare expenditures, at $5,828 US dollars (roughly $7,818 Canadian). In 2020, Canada’s population reached 38 Million. Rough math translates these numbers into an expenditure of $300 Billion on healthcare.
What are we getting for that money? Hardly a day goes by without another nightmarish news story about someone in Canada not receiving appropriate care, many times with devastating consequences. Surely, there can no longer be any doubt that our healthcare system is in trouble.
What can be done about this? Both the federal and the provincial/territorial governments must operate under The Canada Health Act (CHA). It is based on five principles, which are universality, comprehensiveness, portability, accessibility and public administration. The CHA clearly states: “The aim of the CHA is to ensure that all eligible residents of Canada have reasonable access to insured health services on a prepaid basis, without direct charges at the point of service for such services.”
We do not have this reasonable access at this time.
We do not have enough healthcare professionals and providers. We do not have enough facilities for any level of care, be it preventative, non-urgent, emergency, acute, or chronic care. We do not have enough services for home care, palliative care or community-based care. We do not have enough programs for Canadians with special needs.
What we do have is frustration with a universal healthcare insurance program that has ignored demographics in favour of reducing budgets. A system that has reduced admissions to healthcare training programs, believing that this would reduce healthcare expenditures. The irony is that at the same time that admissions were being reduced at medical schools, physicians were given added responsibility to act as gatekeepers to the healthcare system. Where formerly patients could self-refer to specialist physicians, this is no longer permitted.
General and family practitioners take time to see patients, in-person or virtually, before referring them to specialists, even when the need for a specialist is self-evident. Nurses are not permitted to make referrals; nor are pharmacists, physiotherapists or other healthcare professionals. Most provinces have telephone nursing services, designed to channel patients to the appropriate service and away from emergency rooms. Yet the channel still requires a physician’s referral.
Similarly, general and family practitioners as well as specialists take time to order laboratory tests to confirm that blood work is within the normal levels, before ordering refills of prescriptions or changing doses – by sending faxes – to pharmacies. Why can’t pharmacists refer patients to labs directly?
All provincial and territorial pharmaceutical colleges were contacted to determine whether ordering lab tests was part of pharmacists’ scope of practice. 13 organizations were contacted; 9 responded. Of the nine, only 5 provinces approve of pharmacists ordering and reviewing lab tests related to prescriptions – and one of these is approved by the College but not yet approved by the Ministry of Health. The four remaining responses indicated that pharmacists do not have this expanded scope of practice. Instead, patients are bounced from pharmacist to physician (if they have one) to laboratories, back to physicians for the results and then back to pharmacists for prescriptions.
How much does this cost? How much time does it take? We have no way of knowing, as there is no reporting of such information. But at the very least, physicians are billing provincial/territorial ministries of health for two patient visits, in order to renew prescriptions.
Pharmacists are only one example of healthcare professionals who could take the pressure off family and general practitioners. Other examples are nurse practitioners, physician assistants, physical therapists and the like.
Picard’s column generated hundreds of posts online, most by professionals in the healthcare system. These included managers, administrators and policy wonks of all stripes (again including this writer). Perhaps not surprisingly, there were few posts from government workers.
The consensus is that more money is not the answer.
Read that again. More money will not solve the problems of our overburdened healthcare system. What will?
The healthcare system as it now stands is like the proverbial definition of a pleasure craft: a hole in the water into which money is perpetually poured. For a satirical perspective of the system’s problems, don’t miss this video.
More media attention is being paid to the current healthcare system problems. Reports of people denied service or sent home with broken bones and concussions are becoming commonplace. Ambulances are unavailable for hours at a time because medics are waiting at hospitals to admit patients to emergency rooms. Emergency rooms are overflowing and closing in part or wholly because of staffing shortages and inability to transfer patients to appropriate inpatient units. Those inpatient units cannot discharge patients to other levels of care and other institutions. Every level of service is understaffed and overflowing.
For the first time in a long career in healthcare management and policy, I despair for the state of care in this country. I admit that I am one of the approximately five million Canadians without either a family doctor or a nurse practitioner. Following a move from one province to another, I have searched in vain and I now rely on online services with practitioners who are funded to provide Zoom medicine. Full disclosure: I did make it onto one medical practice waiting list and I was assigned number 1,437…
Tommy Douglas, the so-called father of national health insurance, has the following quote on his tombstone in Beechwood Cemetery in Ottawa: “Courage, my friends, ‘tis not too late to make a better world.”
How can we do that? We could accelerate the expansion of the scope of services of non-physician healthcare providers. We could fast-track acceptance of foreign-trained healthcare providers, without bankrupting these people in the process. We could make a serious effort at modernizing record-keeping and record-sharing, even by starting with replacing fax machines with secure emails. We could relieve non-specialist physicians of their role as gate-keepers, returning them to caring for patients. We could remind governments at all levels that they are insurers, not providers of care.
To live up to their obligations under the Canada Health Act, the federal and provincial/territorial governments could request help from the Canadian Armed Services. Military healthcare workers were called in during the COVID-19 pandemic to assist in nursing homes and other long term care facilities. Today’s shutting of emergency rooms is no less an emergency that cannot be fixed in the short term. Emergency rooms need help and they/we need it now.
And Canadians across the country could and should contact their elected representatives at the local, provincial/territorial and federal levels to demand that the goals of the CHA be met.
Accessibility to insured healthcare is a right in Canada. We are not getting what we are paying for through taxation. Politicians respond to their electors. It’s time to tell politicians that Canadians expect more than we are currently receiving from the healthcare system. This is not to blame the healthcare workers. Rather, it is to hold politicians responsible for mismanaging the system to the point we are today.
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