Money alone can’t save health care

Opinion

Hey there, time traveller!
This article was published 18/08/2023 (750 days ago), so information in it may no longer be current.

Last month, an opinion piece in these pages created a misleading impression about this province’s health-care system. “A ‘made in Manitoba’ Crisis” (July 14) decried provincial health-care budgeting as “parsimony” and stated that monetary decisions made by its provincial government since 2015 have created a health-care crisis in Manitoba. Therefore, it is strongly implied that the solution is… more money.

If only it were that simple. And if only the health-care crisis was limited to Manitoba.

There are not enough doctors, patients face long waits for treatment and health-care workers are frustrated. Agreed. But those same factors are at play (to a greater or lesser extent) in every province and territory — it’s called universal health care.

Last week, a new report from CIHI (Canadian Institute for Health Information) showed us how the COVID pandemic exacerbated the decline of health-care across.

About 12 per cent of Canadians do not have a family doctor.

There were 743,000 fewer surgeries performed during the first 2.5 years of COVID and all provinces are struggling with huge backlogs and continually-growing waitlists. Waitlist data from other sources (showing median wait between referral by GP to receiving treatment) show that waits for treatment increased from 19.4 weeks in 2015 to 31.5 weeks in 2021. But waitlists from almost every province increased — in fact, the same waits in Nova Scotia doubled during that time from 26.1 to 53.2 weeks.

The report also documented 18 million overtime hours in public hospitals between 2020 and 2021 — the equivalent of 9,000 full-time jobs so, of course, health-care workers are burning out.

Health-care chaos is not a ‘made in Manitoba’ problem — it’s a Canadian problem.

And, as Canadians have observed over and over again, pouring more money into a broken system is not a solution. Canada already has the second-most expensive health-care system in the world. Health care will cost the average family (of two parents and one child) about $17,000 in 2023. It’s difficult to imagine how much more of tax burden Manitoban (and Canadian) families are willing to endure.

So, what are some ‘systemic’ solutions that could improve Canadian health care?

One idea that seems to be gaining traction is changing hospital funding from huge, black-box global budgets to activity-based funding.

Hospitals represent the largest health-care expenditure in Canada. With global budgets, each patient represents an expense and encourages hospitals to do what they can to reduce access and expenditures. They are also notoriously inefficient for containing costs. By contrast, under activity-based funding, each patient represents a source of income and adds to the hospital’s financial resources. Hospitals are paid based on the number of people treated and procedures performed; this has been shown to increase access to, and cost efficiency of, health care.

Activity-based funding is already in place in some hospitals in Canada — but the vast majority still fall under global budgets. This is just one of many reforms suggested by a task force of emergency department physicians in Canada. Their report has been two years in the making and the draft report is available online.

It will be a significant contribution to the conversation about health care because Canada’s emergency departments serve as the nadir for the constellation of crises that now constitute Canadian health care.

EDs are the first place that patients go when they can’t access a family doctor. They are where hallway medicine begins as a shortage of hospital beds puts patients who need to be admitted on stretchers in busy hallways. They are where geriatric patients find themselves when they have chronic conditions and need the kind of care that should be provided in a long-term care situation or by a family doctor. No wonder the ED report says, “For us to survive, our entire ecosystem must change.”

Another systemic reform that has proven successful in other countries is the “purchaser-provider split.” As the name suggests, this is a model of health care delivery in which the payer for the service is separated from the service providers. That doesn’t happen in Canada — under our public health-care system, the government pays for, and provides the service. One can easily see how inefficient this can be.

Health-care reform is desperately needed, but our federal and provincial governments are out of money. Change can only come through innovation.

Susan Martinuk is a Senior Fellow at the Frontier Centre for Public Policy and author of “Patients at Risk: Exposing Canada’s Health-Care Crisis.”