New health minister should not repeat predecessor’s mistakes
With last week’s cabinet shuffle, Canadians got a new federal health minister. However, if Minister Mark Holland truly wants to be something more than just a new face, he must depart from his predecessor’s heavy-handed Ottawa-centric approach to health-care governance. Instead, the minister must allow provinces to experiment with policies that have a real chance of improving health care.
Across the country, Canada’s media is awash with stories ranging from personal accounts of burned out health-care staff to overcrowded hospitals to record-long wait times for medically necessary care.
Empirically, in 2022, Canadians could expect a median wait of 27.4 weeks between a referral to a specialist by a general practitioner and receipt of treatment—the longest wait on record, and three times longer than in 1993 (9.3 weeks) when national measurements were first made.
While pandemic-related surgical postponements have certainly contributed to increased wait times, Canadian’s were already facing a 20.9 week wait in 2019—before COVID. In other words, when it comes to health care, Canadians have simply gone from one crisis to another.
At the same time, Canada is spending more on health care than ever before and now ranks as the most expensive universal health-care system in the world (as measured by the share of the economy spent on health care).
Clearly, many of the challenges Minister Holland will face are endemic to the portfolio and will not be solved with more spending. Real progress will require genuine reform, and it begins by understanding that the majority of Canadians are concerned about the current approach, and many have indicated a desire for change.
In March, the Angus Reid Institute published a survey that found 69 per cent of Canadians indicated that Canadian health care was either “poor” or “very poor, in crisis.”
Importantly, many Canadians are support a major shake up to how health care is financed and delivered. The survey found that 43 per cent of Canadians believe they should have the ability to use their own money to purchase health care from private providers, with a further plurality of Canadians in every province (except Ontario) supporting the ability of patients to pay out-of-pocket for faster access to some surgeries and diagnostic testing.
Overall, the survey found that the majority of Canadians (61 per cent) were either outright proponents of private care or were curious (albeit hesitant) about these reforms. Only 39 per cent staunchly defend the purely public status quo.
Indeed, a plurality of Canadians also support specific solutions based on the examples of other universal systems around the world. For example, 46 per cent of Canadians support Australia’s use of private insurance for services not covered by the universal public system and faster access in private hospitals, while a majority (60 per cent) support the ability of physicians to practise in both the public and private systems.
A majority of Canadians (52 per cent) also support the use of a private health care system that co-exists alongside the universal public system, as is the case in the United Kingdom, where patients can pay for services not included in the public universal health-care system and procedures with long waits in the public system.
The most relevant finding, however, given current strains in Canada’s system and the fact that several provinces are expanding the use of contracted services with private providers, is the 78 per cent of Canadians who support allowing for the provision of additional surgeries and testing through private clinics (although 40 per cent of respondents only support this in the short-term to clear surgical backlogs).
Together, these findings highlight a clear disconnect between the attitudes of Canadians and the response from Ottawa. Consider last February when the then-Minister of Health chastised provinces that allowed patients to use their own money to purchase health care from private providers, regardless of how provincial premiers and residents viewed the matter.
This is not to say that Canadians don’t have some concerns about these options. For example, more than two-thirds of respondents to the same survey believe that lower-income Canadians will be negatively impacted by these changes, and that the changes could potentially worsen staff shortages. This is why it’s crucial to carefully look at how universal health-care countries that partner with the private sector also build in protections for the vulnerable.
The evidence demonstrates that Canada’s approach to health care at the federal level has been flawed for decades, and is now at odds with the attitudes of a significant portion of Canadians. Ottawa should learn from universal health-care countries that have long understood there’s a role for both private and public sectors in the delivery of universal care.
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