Complex problems require complex solutions

The issue of health care has been at the top of the list of key issues for most, if not all, provincial elections in Manitoba since our family moved to Manitoba almost 40 years ago.

As health-care workers my wife and I immigrated to Canada largely because of the health-care system.

This is a country where people do not declare bankruptcy because of their medical bills when catastrophic illness occurs. This is a country where health-care services are prioritized based on patient needs, not the ability to pay. This is now a country where the health-care system is in a crisis. Would we have moved to Canada had the state of health-care service delivery then been what it is today?

I don’t know the answer to that question, but I do know that my passion for the dream of what our medicare system promises to offer is still strong.

So where did the health-care system go wrong and how can we fix it?

I have spent a good part of my career studying health services, health policy and population health. These are all components of health-care systems. But they are just a few of the many components of this very complex system. Complex systems consist of many parts that interact in complex ways. A change to one part of the system often leads to unexpected changes in other parts of the system.

This is why it is important to take a systems thinking approach when working to address Canada’s crisis in health care.

This means looking at the many interacting factors that have led to the embarrassing emergency room wait-times.

Why do so many people go to emergency rooms (ER) and urgent-care sites when they should (from a system and best possible patient-care perspective) get that care from a family doctor who knows them and their medical history and is easily accessible?

Why do patients who need hospital admission wait so long in emergency departments when they should be in a hospital bed? The simple solution to these intertwined problems is that we need more family doctors, and we need more hospital beds. But neither of these solutions are that simple.

More hospital beds need more nurses to provide care. So we need more family doctors and more nurses. How long does it take to train additional health-care providers? How much does it cost? Which is more of a priority? Can we encourage family doctors to provide care to their patients during evening and weekend hours?

The simple solution would seem to be to pay them more for those services, but many family doctors are exhausted by the time they already spend caring for patients. Why is their work so challenging in 2025 compared to 1995 (“the good old days”)?

We have fewer hospital beds now than we did then, so patients are discharged home earlier in the course of their illness to make room for patients in the ER who need beds (sound familiar?). This early discharge is possible because medicine has advanced with new drugs and treatments, but these patients still need more care from their family doctors than they did in the past. Sicker patients living in the community need closer monitoring, often with home-care nurses playing a key role.

This is another part of the system that needs increased resources (both people and funding) to alleviate ER overcrowding.

As the system struggles to deal with an aging population which is living longer, thus needing care for more chronic diseases including new costly medications, there is less capacity to address the prevention of illness.

The COVID-19 pandemic raised our awareness of the importance of vaccines, which saved thousands of lives and played a role in keeping the system from collapsing, but this past flu season less than one third of Manitobans rolled up their sleeves for a flu shot.

Despite the overwhelming evidence from local research involving the Reh-Fit Centre and Wellness Institute members of the benefits of exercise, most Manitobans do not exercise regularly. We have the dubious honour of being the Slurpee capital of North America despite having some of the highest rates of Type 2 diabetes.

The complex solutions require taking a systems approach from a birds-eye view.

Provincial governments struggle to take this perspective when they are in the thick of a crisis such as the one we currently face. While healthcare services are funded and delivered by the provinces, a significant portion of funding is provided through federal transfers. There have been numerous attempts by federal governments over the years to negotiate additional funding dependent on specific system improvements to be delivered by the provinces.

This piecemeal approach has never proven effective in addressing the complex causes of health-care challenges. Addressing the daily news cycle issues is urgent for those involved but is not an effective way to tackle the complex underlying issues.

A more successful approach may be to base these funding infusions on comprehensive plans that recognize the complexity of the health-care system.

While this may not lead to short-term gains in wait-times or outcomes, it has the potential to address the underlying fundamental needs of the system. This funding would include multi-year transfers, where each year’s funding is based on achieving predetermined milestones on the journey to system rehabilitation. This approach has the potential to transform our health-care system into the high-functioning system we need.

Alan Katz is a senior scientist at the Manitoba Centre for Health Policy.