Canada’s Eternal Debate on How to Solve Health Problems

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By Mia Rabson, The Canadian Press August 28, 2021.

Dr. Katharine Smart, President of the Canadian Medical Association, poses in an undated photo. Canada’s universal healthcare system is among the most beloved and debated policies this country has ever had, but the COVID-19 pandemic has done more than ever to expose the weaknesses of the system. THE CANADIAN PRESS / HO-Canadian Medical Association, * MANDATORY CREDIT

OTTAWA – Canada’s universal healthcare system is among the most beloved and debated policies this country has ever had, but the COVID-19 pandemic has done more than ever to expose the weaknesses of the system.

According to some experts, it has also provided ways to solve the problems of healthcare in Canada, with the rapid introduction of more virtual care among the highlights.

“What the pandemic did was it made, I think, everyone in Canada aware of the fragility of our current system,” said Dr. Katharine Smart, Yukon pediatrician and Association president. Canadian medical.

“People understand how important it is to have a highly functioning healthcare system and that our foundations are cracking. “

The question is how to fill these cracks. The three major national political parties are promising some form of health care improvement starting with pharmacare and hiring more doctors to increase federal health transfers to the provinces.

No one seems to dispute that the system needs more money. The dispute that arises concerns the source of this money.

Smart said Canadians have an “illusion” that health care is entirely public, but the reality is that the system is already a mix of private and public. Most medical clinics and surgeries, and even some hospitals, are private companies, whose fees are paid by public health plans.

But public plans don’t cover everything, and Canadians pay out of pocket for things like eye exams, physiotherapy, dentistry, some mental health treatments and prescription drugs. In 2019, 30% of the $ 266 billion spent on health care was funded by the private sector.

The Canada Health Act sets out the conditions that provinces must meet in order to receive all of their federal transfers for health care. If provinces charge patients for these services, their transfers can be clawed back.

In recent years, recoveries have been made in British Columbia, Newfoundland and Labrador and New Brunswick after patients were billed for services covered by the law.

The next target will likely be a Saskatchewan policy allowing private MRI clinics to charge patients for exams, provided they provide free exams to an equal number of patients on the public waiting list. The policy has been in place since 2016, but the Liberals updated the Canada Health Act in 2018 to specifically add diagnoses, and this change will come into full effect in 2022.

Conservative Leader Erin O’Toole has opened the door to allowing provinces to do more of what Saskatchewan has done, praising the policy during the Conservative leadership race last year and promising more “public synergies.” private ‘in health care.

Last week he declined to be more specific on services he thinks Canadians should be allowed to pay for directly, saying only that he fully adheres to Canada’s publicly funded health care system, will increase transfers to the province to pay them and let them decide how to innovate.

“If Saskatchewan, Alberta, Ontario or Quebec want to innovate to provide better health care, I support that,” he said on August 24. ” Why? Because it gives Canadians more choice. The more health care choices Canadians have, the better.

Trudeau said on Friday that what O’Toole means by “choice” is “that rich people should be able to pay and get ahead and get private services,” which he said would only do increase waiting times in the public system.

“Conservative politicians, like (Saskatchewan Premier) Scott Moe, like Erin O’Toole, are all for a health care system for the rich and a health care system for everyone, but I don’t agree with that and I know Canadians disagree with it, ”Trudeau said.

Dr Shoo Lee, a pediatrician and professor of public health policy at the University of Toronto, co-authored a paper published in February, which examined whether greater use of private funding improves accessibility or quality. health care in other countries, and concluded that no.

“Private funding (both private for-profit insurance and private funding) has been shown to have a negative effect on universality, equity, accessibility and quality of care,” the paper concludes. . “The increase in private funding has not been associated with better health outcomes, nor has it reduced the growth in health spending. Therefore, increasing private finance is not the proposed panacea for improving quality or sustainability. “

In an interview, Lee said private for-profit healthcare means some of the funding for healthcare services is diverted to profits, which ultimately costs more money.

Smart said public systems can be innovative without charging patients, if they are properly funded and have the ability to do so.

Virtual care is among the new innovations that exploded during the pandemic out of necessity, but which Lee believes could have a long-standing impact on overall healthcare delivery.

Doctors in most provinces can now be paid for virtual office visits and phone calls. Before the pandemic, these services were not paid for if they were provided. And Lee said not all doctor visits have to be in person. Prescription renewals, for example, often require little more than a conversation, and virtual care allows this to happen more efficiently.

Smart said virtual care could also be a major improvement in access for people in places where certain specialists do not exist or are scarce. But she said the provinces and Ottawa must do more to enable national recognition of medical degrees, so that a doctor in one province can provide virtual care to a patient in another.

Or, Smart said, maybe instead of sending patients across provincial borders to see specialists, specialists can come to their homes. Unless a doctor is licensed in more than one province, he currently cannot do so, Smart said.

Smart said there must also be a national conversation and agreement on how many more doctors and nurses Canada needs. Growth in the number of new physicians has exceeded that of the population for years, but Canada still has one of the lowest physician-to-patient ratios in the OECD.

This report by The Canadian Press was first published on August 28, 2021.

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