The sad state of the Health Care System in Canada

by Maj (ret'd) CORNELIU E. CHISU, CD, PMSC, FEC, CET, P. Eng. Former Member of Parliament Pickering-Scarborough East In the aftermath of the COVID-19 pandemic, Canada's health-care system appears to be crumbling. Canada is already one of the biggest spenders in the OECD when it comes to health care, yet it seems that our system was not designed to handle a massive crisis like a pandemic. Ontario, and indeed Canada, are in a protracted health system crisis marked by waiting lists, ER shutdowns and shortages of critical health care professionals. Despite decades of fierce public debate and escalating budgets, Canadian wait times continue to get worse. For "medically necessary" treatment, patients wait an average of 20.9 weeks from referral to treatment, in addition to the wait time to see the family doctor in the first place. In less populated areas, wait times can stretch dramatically longer. By one estimate, over one million Canadians-3% of the entire population-are waiting for medical treatment at any given moment. These waiting lists can average six months, and often much longer in areas that suffer from such extreme staff shortages that many cannot even find a family doctor. With one million waiting, many Canadians turn in desperation to health care in the US and other countries, where Canadians who are prepared to pay can get very high-quality care without waiting. In 2017 alone, Canadians made 217,500 trips abroad for health care, paying out-of-pocket to skip the queue. Beyond rationing care using waiting lists, Canada's monopoly health care also underinvests in equipment and staff. Canada has 35% fewer acute care beds than the US and one-fourth as many MRIs per capita-indeed, it has fewer MRIs per capita than Turkey, Chile, or Latvia. As a result, Canadian MRI waits average over 9 weeks, adding months of diagnostic delays to months of treatment delays. Even routine diagnostic exams like ultrasounds have almost four-week waiting lists. Canada's underinvestment in medical staff and doctors, ranks it 29th out of 33 high-income countries for doctors per 1,000 populations. Having half as many specialists per capita as the US, should the lengthy wait times for specialty treatment be surprising? One recent trend in Canada is for medical providers to initiate "One issue per visit" rules that force patients to make multiple appointments, not only inconvenience the ill and suffering, but extend waits as patients work through their medical issues appointment by delayed appointment. As one doctor who follows this practice recognized, such tactics raise "a big ethical question about rationing health care in a public system" and whether patients are denied treatment as a result. Solving the acute problems of the health system has electrified Canadian politics - whether or not there should be more privatization in health care. The perennial debate over privatization has been accompanied by the other usual approaches to improving the system, including additional resources and reorganizing delivery to improve efficiency. One might argue that this time the rhetoric must lead to action, given that staff shortages have worsened working conditions for doctors and nurses and longer shifts are burning out staff. At the same time the call for more resources should be weighed against the experience of the aftermath of the "Romanow Report" that led to the six percent Canada Health Transfer Escalator that was supposed to buy transformative change in the health-care system. Yet, two decades later, we are facing a lot of similar issues - overcrowded ERs, lack of after-hours access to family physicians, waiting lists. So really, we need to rethink the administration of the health care system; we probably need a new design. But after two years of pandemic burnout and a backlog of surgeries combined with COVID-19 resurgences, how do we press water from a stone? At the same time, many health sector workers are seeking better work-life balances though not necessarily reduced compensation. The administration of health care rests with the provinces by law. The federal government provides funding but is not involved in the administration and does not have the tools to verify how the money is spent provincially. Another major problem left unaddressed is the licensing of medical professionals. The provinces make the decision on licensing the practice of professionals, including health care professionals, through the regulatory bodies. Limited licensing is now putting a brake on providing adequate health care by limiting the number of doctors and nurses. The universities, in consensus with the regulatory bodies establish the number of yearly places available in the medical schools. This may seem like a fair process, but I see it as a way of protecting the market in limiting the number of doctors performing work, thus assuring high remuneration. In practice, they make it extremely difficult for foreign trained doctors to be licensed, propagating a monopoly on the health care market by eliminating competition. If this is to change, as it must, we need the political will, understanding of the problem, and the competence to act meaningfully, both at the federal and provincial levels. The tools to do so are provided in legislation, but they must be acted on soon. Across the country Canadians are struggling with inflated wait times at hospitals, closed emergency departments, shrinking access to ambulances and long-term care, among other impacts, as the health-care system limps along. Data from the Canadian Institute for Health Information shows admitted patients across Canada waited 38.3 hours in emergency rooms in 2019-2020, up from 29.3 hours five years earlier. The total number of visits spiked to nearly 1.6 million during that time, up from just over 1.1 million. Across the nation, five million Canadians lack a primary health-care provider, when primary health care is key. If individuals can't take care of themselves, how do they avoid ending up in hospital? "We don't have enough doctors or nurses to be able to take care of all the Nova Scotians and Canadians that need access to care," Dr. Leisha Hawker, president of Doctors Nova Scotia, recently told CTV News. Doctors and nurses coast-to-coast are saying they can't keep up with the demand. Morale is at an all-time low, according to Tim Guest, president of the Canadians Nurses Association. "I would say that nurses are exhausted, they're burnt out, they're demoralized," he told CTV News. So isn't it time to reshape our health care system? Are our politicians ready? You decide.