Policymakers should consider health-care reform in post-COVID world

The COVID-19 crisis has led many provinces to take drastic measures to both limit the spread of the virus and ensure scarce medical resources are available, including cancelling thousands of elective surgeries in provinces such as Ontario and British Columbia.

These cancellations are creating a growing backlog that must be addressed once the worst of the pandemic is over. But will our health-care system be able to manage and absorb this backlog and, if not, is there anything we can do about it?

First, even in ordinary circumstance (let’s call this the “pre-COVID” world), our health-care system struggles to address routine demand for patient care. A recent report revealed that almost half of all hospitals in Ontario regularly operate beyond capacity. In the post-COVID world, we should expect a return to this unfortunate situation—except worse, due to the thousands of patients whose surgeries have been postponed.

Secondly, even in the pre-COVID world, patients could routinely expect to wait almost 21 weeks for elective treatment (after referral from a family doctor). It’s not unreasonable to expect this situation to deteriorate in the post-COVID world.

Of course, other countries around the world have also stopped or curtailed elective and scheduled care. However, many of these countries have far more medical resources than Canada does and may be able to better absorb the impact of these cancellations. For example, Canada reports an age-adjusted ratio of just 2.0 acute-care beds per thousand people, far less than countries such as South Korea (8.1) and Germany (5.5). Canada also has relatively fewer physicians per capita, ranking 26th out of 28 universal health-care systems.

Again, while just about every country will likely also experience increases in wait times for treatment, most will start from a much lower base-line wait compared to Canada. For example, in the pre-COVID world, significantly more Canadians (18 per cent) reported waiting four months or longer for elective surgery in 2016 compared to, for example, Switzerland (6 per cent) and Germany (0 per cent).

So, how can we prepare for the post-COVID world?

One option would be to embrace the private sector as an ally. Unlike Canada, many other universal health-care system around the world will have the private sector on standby to provide elective surgeries. There are three distinct potential advantages for Canada to follow a similar approach. First, by contracting services out to existing private clinics, Canada’s public health-care system can potentially serve more patients without having to invest in expensive infrastructure (as previously demonstrated in Saskatchewan). Second, by allowing patients to pay for treatment privately, the private sector can act as a pressure-valve and potentially alleviate stress on the public system.

Finally, unlike the public sector in Canada, a robust and independent private sector isn’t bound by government budgets or competing with other social programs. This will allow for a dynamic response where the private sector can flexibly expand to absorb the surge in patient demand and contract once demand stabilizes.

To be clear, Canada has been fortunate to have fewer cumulative cases per million than many other developed countries. Further, our health-care professionals and policymakers have been exceptional in dealing with this crisis, and they deserve all of our support.

However, the blanket cancellation of elective surgeries is creating a backlog of patients who need elective—but medically necessary—care. We must consider policy options to assist them in the post-COVID world.