In my last article for BenefitsCanada.com, I compared and contrasted the state of healthcare in this country at the time that the basic principles for the Canada Health Act were conceived (in 1961) and today.
As the federal government is about to undertake a review of this legislation, it’s important that all Canadians formulate a point of view on the future of our healthcare system. Employers in particular have a vested interest in the outcome of these deliberations, given the interrelationship between the public system and employee benefits programs.
First, an important acknowledgement: the healthcare debate is charged with emotion. Canadians from all walks of life have different experiences with our healthcare system, and these form our opinions. My own experiences with our system have been generally favourable—others I know have had completely difference experiences. Additionally, there are those Canadians who are also health professionals working within the system who are constantly asked to do more with less. The perspectives of the multiple stakeholders are of equal importance in the deliberations of the future of healthcare in this country. Weighing each perspective is the next-to-impossible task put before the government as it develops a template for Canada’s healthcare system that will last another 50 years.
So with this very important caveat, let’s consider what currently works well within our current healthcare system and what does not.
What works well
No Canadian is left behind – Unlike in the U.S., no citizen of this country is denied access to healthcare based on whether or not he or she can afford to pay. This is a point of pride for many Canadians and clearly distinguishes us from our neighbours to the south. Universal healthcare defines us as Canadians.
Excellent standard of care – Once you are in the system, the standard of care is excellent. For example, health outcomes in the areas of cardiovascular disease and many forms of cancer are far better than in the U.S., which suggests that we are doing many things right. Of course, the operative words here are “once you are in the system.” Clearly, reasonable access to care is an issue that this country must address.
Funds go to healthcare, not administration – For the most part, our Canadian system efficiently allocates funds between healthcare provision and healthcare administration. For every dollar spent on healthcare funding, far less gets spent on administration than in countries such as the U.S. Our system is far from perfect, but in relative terms, it is not bad.
What does not work well
Our healthcare system is costly – Canada has one of the most expensive healthcare systems in the world. We can look to many other countries to see superior health for less money. Our single-payer model works in theory, but, in practical terms, it has not delivered the results that one would have necessarily expected with respect to value for money.
Healthcare decision-making is political – Healthcare decisions are often made based on “political palatability” or what’s acceptable to the voting public versus what makes sense from a financial sustainability perspective or in terms of health outcomes. The decision-making process is complicated and often slow, and results in small incremental change rather than fundamental change. We are likely at a point in time where we need to ask the tough questions—but the politics of decision-making will get in the way and we may not get to where we need to be.
Access to care is a significant problem – Restrictions on government funding has limited access to care—wait-lists are routine, and Canadians are increasingly having difficulties accessing the services of family physicians. The system has not kept up with the demands and expectations of the patient.
The healthcare system is not very nimble – Our healthcare system is huge and, therefore, not very nimble. Although many provinces are trying to change this, our system remains focused on acute and chronic care—addressing the problem once it becomes a problem. Most experts agree that the focus should shift to prevention and health promotion. This is a monumental shift that is going to take time. The system has also not kept up with the changing face of illness and treatment. For example, physical health remains the primary focus of the system while mental illness represents a significant cost to the Canadian economy and society. Drug therapy is used extensively in the treatment of injury and disease, yet these costs fall largely outside of the public system.
Not all Canadians are treated the same – We have a universal healthcare system and yet—in some respects—this is also a misrepresentation. Healthcare funding across the country is far from consistent with access to care defined, in part, by your province of residence. And this gap will only get larger as resource-rich provinces such are Alberta and Saskatchewan are able to invest more on a per capita basis than the other provinces. Health transfer payments are supposed to compensate for these funding imbalances; however, the fact of the matter remains—our healthcare system is far from universal.
So where to from here? Many of the basic principles embedded in the Canada Health Act still work. However, this important piece of legislation needs to be modernized to reflect the realities of today. The principles of public administration and the guidelines for what is “medically necessary” in particular need to be reviewed to ensure that whether what was anticipated in 1961 still works today. And we need to ask the hard questions—the questions no politician wants to ask—to ensure that we establish the most appropriate path for our future.
We can probably all agree on the objective—to develop a framework for a cost-effective, efficient healthcare system that responds to the medical needs of all Canadians. How we get there is subject to debate. But we do need to get there, and the debate needs to start now.