The System Too Big to Fail

The subject of boasting to Americans is utterly broken, though no one will admit it on the other side of the border:

Funding cuts, fewer generalists and inefficient organisation are preventing more and more Canadians from accessing public primary healthcare, according to a new study published in the Canadian Medical Association Journal (CMAJ) which compares Canadian healthcare unfavourably with public systems in nine Organisation for Economic Cooperation and Development (OECD) countries.

About 20% of Canadians have no family doctor at all, and many more have irregular access to clinicians – a reality likely to worsen if not properly addressed now, said Dr Tara Kiran, a family physician in Toronto and one of the authors of the study.

“In Canada, what we have is a haves-and-have-nots situation,” said Kiran. “[There are] people who do have access to a family doctor and sometimes even a health team, and then those who have nothing.”

(Sidebar: it's not a class struggle but systemic failure. However, Dr. Kiran, you know this.) 

The CMAJ study, led by family physicians and researchers at the University of Toronto and published on Monday, compares the Canadian healthcare system with those of Denmark, Finland, France, Germany, Italy, the Netherlands, New Zealand, Norway and the UK. Those countries were chosen because 95% or more citizens have access to a family physician.

Among the study’s chief conclusions is that countries that design healthcare systems around the principle of guaranteed access have far different – and usually better – outcomes than those in Canada.

Important comparative differences included higher rates of primary care funding, more doctors, better organisation and information systems support and greater physician accountability to the public insurer.

But perhaps the biggest difference, said Kiran, is that “they set a goal that primary care is something that should be guaranteed to everyone in the population, and they design around that”.

She pointed out that Norwegians and Finns are automatically registered to a doctor or health centre, and those in the UK have a right to register with care providers in their immediate communities.

The study also noted that relationship-based care with a single clinician is associated with better patient outcomes.

Many Canadians, however, wait for years on provincial family doctor waitlists. Others have to call around town in hopes of finding someone willing to accept them. In the interim, they cobble care together through urgent care clinics, hospital ERs and, in some cases, private out-of-pocket services.

In Canada, each province or territory is responsible for running its own healthcare regime. Drawing from their tax bases, provinces splits healthcare costs with the federal government. However, the federal government now only covers about 22% – a significant decline from the 50% it promised in the 1970s to help incentivize the creation of public healthcare regimes.

The CMAJ study also shows that at 5.3%, Canada spends less of its total health budget on primary care than other OECD countries. In those countries, primary care spending constitutes an average of 8.1% of total healthcare budgets, the authors wrote.

Research on Canadian healthcare shows declining funding puts increasing pressure on healthcare services and resources across the country – a trend that has, in recent years, enabled increasing privatisation of care in some Canadian jurisdictions.

By and large, primary care providers in Canada are autonomous small business owners that get reimbursed by the government for services provided to rostered patients. This structure is the result of a hard-fought battle waged by Canadian doctors at the advent of the public system.

That model may be losing its lustre, however. Kiran said that more and more Canadian medical school graduates are losing their appetite for the self-employed, fee-for-service model on which Canada currently relies in favour of greater work-life balance.

With shifts like these, the CMAJ study suggests Canada may be forced to chose between continuing to pour money into a broken system, and reimagining it entirely.

The answer, of course, is more funding but never re-examining the system, privatising it (even partially), training and keeping specialists in the country, not burdening the system with unnecessary procedures or flooding the system with people who have never paid into the system in the first place.

Heaven forbid.

**

The number of Canadians dying while on wait lists for surgery or diagnostic scans has reached a five-year high, according to numbers gathered by government policy watchdog SecondStreet.org.

The group’s latest policy brief, titled Died on a Waiting List, claims that government data collected through Freedom of Information requests show more than 17,000 patients died while on wait lists in 2022-23.

This includes patients waiting for potential life-saving procedures such as heart operations, and those waiting for quality-of-life operations such as hip surgery. Times on the wait lists varied from less than a week to more than 10 years.

“We’re seeing governments leave patients for dead. It’s deplorable,” said SecondStreet.org president and report author Colin Craig. “More money won’t solve the problem. Governments have tried that for 30 years. Only meaningful health reform will reduce patient suffering.”

The report points out that annual per capita government spending on health care has increased to $5,607 from $1,714 since 1992, a rate double that of inflation over the same period.

But despite that, data from health care bodies that provided information each of the last five years found an increase in surgical wait list deaths of 64 per cent. In Ontario alone, 101 patients died while waiting for heart surgery, and more than a third of those had been on the list longer than the maximum recommended wait times.

Can one guess who the Canadian public want to fix this mess?

The very people who put us here in the first place:

A majority of Canadians think the federal government should spend more on health care, a housing strategy and initiatives to ease inflation and cost-of-living issues, a new poll suggests — but they also want it to freeze or reduce other spending.

Nearly three-quarters of respondents to the new Leger poll, or 71 per cent, said the federal government should spend more on health care and health transfers to the provinces.

Only three per cent of the 1,545 Canadian respondents polled over the weekend said the government should spend less.

Somewhat related - the people MAID was designed for:

The number of Canadians with at least one disability has doubled in 10 years, a reality that should push governments to help reduce barriers to accessibility, says the head of a human rights organization.

Statistics Canada data shows that 27 per cent of people 15 and older — about eight million Canadians — reported having at least one disability in 2022, about twice the percentage of people who reported a disability 10 years ago.

Collected every five years, the StatCan numbers are important because they influence government policy at the federal, provincial and local levels, Heather Walkus, national chair of the Council for Canadians with Disabilities, said in a recent interview.

“At least eight million Canadians have a disability and we are still excluded, not able to join in with families and be part of the Canadian experience because of environment, because of attitudes, and because of the way the system is set up to ensure there's no success or little success,” Walkus said.

Of the millions of Canadians with a disability, 72 per cent reported having encountered some form of barrier to accessibility within the last year; 60 per cent of the eight million said they had experienced barriers navigating indoor and outdoor public spaces.