‘Dying on wait-lists’: Could private health-care solve Canada’s ER ‘crisis’? - "Dr. Michael Rachlis, public health physician and adjunct professor at the University of Toronto, said privatization is not the solution as it creates inequalities, costs more and compromises quality of care. “Privatization of anything would make no difference in the emergency room wait times next week or a year from now. It’s just zero difference. They’re completely different issues.”... Even the U.K., which has a revered universal health-care system, offers private options."
Privatisation won't change anything in a year, so it shouldn't be done. By this logic, there was nothing wrong with restricting medical school admissions in the 90s to save money, since the problems didn't show up in a year
Ottawa’s new dental care benefit offers lessons for health-care reform - "According to an Angus Reid poll released in August, 66 per cent of respondents believe “there are bigger challenges that money can’t fix” in health care. Interestingly, 51 per cent of respondents indicated that the gains from Ottawa’s $46.2 billion injection of health spending will at “best” be “marginal.” Simply put, Canadians understand we need real changes in how health care is financed, regulated and delivered if we’re to achieve better results. The data from international comparisons support these opinions... The lessons for health reform exist in what the Trudeau government did not do with its dental care benefit. It did not eliminate private insurance as was effectively done when universal health care was introduced. It did not nationalize dental facilities to minimize the private sector’s involvement in the delivery of dental care. And it did not bureaucratize the pricing of dental services. Instead, it left the existing dental care market largely untouched and simply provided eligible families with a cash transfer to allow them to purchase dental care in the existing market. This basic design, which allows the market, even in a limited sense, to function, is the common approach in many high-income industrialized countries such as Switzerland that provide universal health care. That includes allowing private providers (i.e. physicians and hospitals) including entrepreneurs to figure out the best way to service patients, allowing prices—to varying extents—to be set through the interaction of health-care providers and patients, and allowing the entrepreneurial process to drive innovation while subsidizing health-care access for lower-income and vulnerable citizens. Moreover, Canada itself has limited but successful experiences with harnessing the productive power of private providers within our universal health-care system. Consider, for instance, that Quebec in 2022 outsourced more than 1-in-6 day surgeries to private providers. Or consider Saskatchewan’s Surgical Initiative (SSI) from 2010 to 2014, which used private clinics to deliver some publicly-funded surgeries at an average cost of 26 per cent less than comparable government facilities. The result was a dramatic drop in wait times for Saskatchewanian patients from 26.5 weeks in 2010 (longest outside Atlantic Canada) to 14.2 weeks in 2014, the second-lowest in the country."
It's not a partisan issue. Our health-care system needs a radical rethink - "Canadian political discourse has become so stilted and steeped in ignorance in recent years that it is blithely accepted that no one who is conservative-minded — with a lowercase or capital “C” — could prioritize an issue like health care, at all. The accepted wisdom is that compassion and social issues are the exclusive domain of partisan liberals and other left-leaning parties; that the conservative DNA rejects such matters in favour of tax cuts for the wealthy. Or slashing social benefits. A nasty and brutish lot, they are. And it is precisely this sort of brittle and simplistic thinking that has landed the Canadian health-care system in its current mess. In recent years in particular, conservatives have been branded as heartless, rapacious capitalists who value wealth accumulation above all else. It is the “progressives,” who preserve the humanity and decency in our society. Life, and politics, are just not that binary. “Conservative” has become synonymous with “un-Canadian” and to have the temerity to question progressive truths, even in the spirit of the public interest, is “un-Canadian.” To disagree and, god forbid, possibly hurt someone’s feelings, is “un-Canadian.” And conservative-minded Canadians, it would seem, are seen by many compatriots to be, well, un-Canadian. Apparently, the right-of-centre species is devoid of empathy or any real sense of social responsibility. This sort of next level smugness has become deeply entrenched in the last six years. And it is a profoundly alarming development that threatens civil discourse and democratic fundamentals. Like exercising the right to free speech... we are stuck in the last century, fixated on this obsolete model of spending more, changing nothing and criticizing no one. Having been a long-time client of Canadian health care, in Toronto, specifically, and now covered by state-funded universal health care in Israel, in Tel Aviv, specifically, I feel qualified to opine and compare. And the overarching observation is that Canadian health-care systems have a lot to learn from Israel. Interestingly, so much of the reform of the Israeli health care system in recent decades has been overseen and driven by right wing governments... Until the late ’80s, Israel was a borderline third world state: a socialist, agrarian economy with triple digit hyper-inflation... Israel today is a dramatically reinvented nation with a flourishing innovation-based economy. It didn’t just happen spontaneously. Such an extreme makeover is planned. Listings of Israeli companies on NASDAQ, the secondary New York stock market, are third in number, after China and the U.S. That statistic is insane. Israel is a country with a population of nine million people and previous few natural resources. Virtually all Israeli NASDAQ companies are in biotech, pharma, cyber security, medical tech. And, in 2020, Israel, which so many still associate with oranges and blooming deserts, surpassed Canada in per capita GDP... along with a reinvention of the national economy, Israel has kept apace with much-needed innovation in the health-care sector. For Canada, there are four significant factors to take-away from this brief comparative study...
Competition. Health care in Israel is state funded and comprehensive. By law, each citizen is required to register with one of four competing health care providers. Yup, there is competition in the state funded system. And this transforms the health culture. And leads to greater efficiencies...
Digitization. For more than 20 years now, the Israeli health care system has been fully digitized. What does that mean? It means that all your health information is stored digitally and whenever you present at a doctor’s office, the hospital, an after hours clinic, the staff have instant access to your full medical history. So you don’t waste all that time trying to remember medications, last time you had your tetanus shot, never mind all the basics, like name, age, address. The time wasted on such redundant information gathering in Canada, that is siloed and not centralized, must be astronomical. Wasted time is wasted money on administration that should and could be diverted to patient care and services...
Preventive medicine... routine blood testing done in Israel is simply not on the menu in Canada unless one is prepared to fork out thousands of dollars annually. This testing is age-based, comprehensive and modified, as necessary, to address individual issues. Blood tests are far less costly, in the short and long runs, in detecting early signs of medical problems and treating them before they become acute...
Private options. As existed in Canada until the Mulroney government amended the Canada Health Act in 1988, Israelis have the option of using the public state-funded system or going private. Doctors, too, can split their practices between public and private systems. It’s a critical element of a well-functioning health-care system: allowing physicians to practice in different environments which, ultimately, enhances their sense of autonomy and engagement and, again, quality and efficiency of patient care. Every Western country offers state care with a private option as well... it acts as a pressure valve, allowing professionals greater independence. Unlike in Canada, they are not fully controlled, financially, by the government. So, if they choose to engage in a split practice, for whatever reason, they are free to do so. More than ample evidence and studies confirm that such freedom facilitates more robust research environments and holistic treatment of patients. Like it or not, the concept of risk and reward motivates even medical professionals...
It’s not a right wing-left wing thing, not by a long shot. The system in Canada is broken and in desperate need of a radical re-think. Canadians really ought to hold themselves to a higher standard. “It’s good enough” or “look how much better and nicer we are than America” just isn’t good enough. At least, it shouldn’t be."
Damn neo-liberalism!
How to fix Canada's broken health care - "Susan Martinuk in her book on Canada’s health care crisis noted that Germany, which has excellent health care, has one-tenth the number of health care administrators, one for every 15,454 citizens versus one for every 1,415 citizens here in Canada. It is hard to see how this large difference is justifiable... Canada now spends about 12.5 percent of GDP on health care, an amount similar to Germany and Switzerland... As development director of a hospital-based imaging centre, I experienced firsthand the bureaucracy and extra cost associated with mandated hospital-grade ambulatory clinic and imaging space. Most ambulatory care should be provided in high quality, efficiently run, less expensive commercial space, either purpose-built or rented. This will reduce capital costs of construction and operating costs and improve the patient experience. Current long wait times for many surgical procedures are due to a lack of allocated OR time and guaranteed scheduling. Hospital operating room time is limited and highly competitive. As a result, highly trained surgeons with large patient backlogs have confided to me that they sit idly by, unable to book procedures and operate efficiently because of this challenge. One important solution is the creation of dedicated surgical centres of excellence. A model already exists in Toronto for cataract operations. The Kensington Eye Institute is an excellent example of a highly efficient, stand-alone, not-for-profit ophthalmology centre that provides state-of-the-art day surgery in an out-of-hospital setting. Such models would also work well for orthopedic and other surgeries that can be done as day surgery. Reducing current hallway medicine is a problem that requires complex, innovative solutions. We can reduce hospital ER visits by greater availability of 24-hour urgent care clinics. Better triage of who needs to visit a hospital can be achieved by broader use of nurse practitioner telehealth calls, as well as the use of artificial intelligence-based decision making about which level of care is required. Such a program has already been developed by an Israeli company, Diagnostic Robotics. A number of in-home care models have been developed primarily in the U.S. that can be trialed in Canada... in-home care can potentially reduce admissions to the hospital, as well as allow for earlier discharge, shortening the length of stay and reducing high in-hospital costs... A hub and spoke model can bring integrated care teams to remote areas."
Damn conservative politicians underfunding healthcare!
Canadians dying while on medical wait lists reaches five-year high, report finds - "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."
Clearly even more money is needed!
Ottawa’s heavy hand frustrates health-care reform in Alberta and beyond - "the CHA, and the conditional federal cash transfers tied to it (an estimated $49 billion this year), has curtailed the ability of provinces to innovate and experiment with any meaningful health-care reform. Simply put, the CHA is not serving Canadians—including Albertans—well. Canada’s health-care system offers less availability of physicians and diagnostic technologies—and some of the longest waits for access to emergency, primary, specialist and surgical care—compared to other universal access health-care countries in the world. Despite repeated claims from politicians and members of the media, this is not the result of underfunding. In fact, Canadians pay for the world’s most expensive universal access health-care system (as a share of the economy). In fact, countries such as Australia, France, Switzerland and Germany spend less than or a similar amount as Canada (as an age-adjusted share of their economy) but perform better on many measures of access and performance including the timeliness of medical services. Why? These countries have a very different policy approach where patients are free to use private clinics outside the universal system. The private sector is accepted as either a partner or pressure valve, and not perceived as a threat to universality. And each of these countries expect patients to share the cost of care (while offering protections for low-income and vulnerable populations)... Among the protectors of the failed status quo, there’s no debate about the merits of existing policy and how a new provider or change might be managed. There’s no discussion about the consequences of past policy choices and how other countries have successfully solved the same problems in their universal systems. There’s only a renewed commitment to the failed model in place today, with vague promises of improvement and ever greater spending."
Canadian doctors trained at international medical schools increasingly giving up on their home country for work - The Globe and Mail - "With nearly 300 Canadian students enrolled in its programs, the Royal College of Surgeons in Ireland feels a lot like a medical school in Canada, just separated by 3,340 kilometres of Atlantic Ocean... More than 40 per cent of the students in RCSI’s four-year medical program are from Canada – more than any other nationality. To help them feel at home, the students organize celebrations for Canadian Thanksgiving, annual Terry Fox runs and road trips to watch professional ice-hockey games in Belfast. Even the curriculum is geared toward a career in medicine in North America – with an academic calendar built around the writing periods for Canadian and U.S. medical exams... They’re leaving Canada because it’s nearly impossible to get one of the 2,800 first-year seats in the country’s 17 medical schools – where roughly nine out of 10 applicants are rejected, often despite impeccable grades and qualifications, since demand far outstrips supply. Many want to come home but can’t. These international medical graduates are increasingly working as doctors in other countries, where they’re highly coveted, because they’re often blocked from returning to Canada by a system that’s been slow to respond to crippling physician shortages here... Provinces and medical faculties also need to create more training residencies for international graduates, which is one of the most cost-effective ways to solve Canada’s worsening health-access crisis. Between its domestic and international graduates, and thousands more immigrant physicians who live here but don’t work in their field, Canada has more than enough doctors to help the country fill shortages in family medicine, clinics and hospitals. But for many physicians who did their studies overseas, the road to a medical career in Canada remains closed because of a lack of provincially funded residency positions – the two-year-long, postgraduation supervised training period required to become a licensed physician. International graduates must compete for a separate and much smaller pool of residencies than those available to graduates of Canadian medical schools. There is no other stream for Canadians who have gone overseas to study – they’re seen as every other international student in the eyes of our medical system... Because it’s so hard to secure a residency position in Canada, these medical graduates are choosing to work in countries such as the U.S., Britain and Australia, where the barriers to entry are lower for Canadian and other international medical graduates. While dozens of RCSI graduates do return to Canada every year, most end up in the American health care system, where international grads are on equal footing with domestically trained medical students... Prior to 1970, medical students were assigned residencies through the Canadian Association of Medical Students. Since then, CaRMS has filled this role, designed to be independent of political interference and governed by directors from Canada’s medical establishment, teaching programs, regulators and licensing bodies. Only one of its 17 board members represents the perspective of international medical graduates... Those trying to find fixes for Canada’s doctor shortage say the most cost-effective solution is to create more training residencies for international medical graduates, at a fraction of the cost of creating new seats at our medical schools... Some other developed countries, meanwhile, have medical systems that streamline the addition of international physicians into their hospitals and clinics. In Britain, international medical graduates aren’t required to do a residency to begin working. Instead, entrance into the British medical system is more of an apprenticeship, done under the supervision of a senior physician, typically in a hospital or community clinic setting. Australia uses a similar system, building residencies and internships into medical students’ training prior to graduation. Internationally trained physicians don’t need to spend two years in a residency program to begin working there and can apply to become a general practitioner after passing clinical and written exams and a 12-month on-the-job supervision period."
Clearly the problem is conservative governments underfunding healthcare, and protectionism blocking international graduates from practising is good and needed to protect people
Gen Z doesn’t care about your public health care hang-ups - "What do you do when big problems can’t be solved by writing big cheques? This is the problem facing Prime Minister Justin Trudeau, and it’s increasingly clear he can’t figure it out. It’s true that the country’s fiscal picture is getting bleaker, that the cost of public borrowing is getting higher, and that inflation and high interest rates call for greater fiscal restraint. It’s also true that the Liberals seem incapable of confronting these facts, kicking the can of tough spending decisions down the road and avoiding the problem as it gets worse. But the bigger challenge—for both today’s government and whoever forms government soon—is that neither fiscal restraint nor increased spending can fully address some of the biggest problems plaguing the country. The supply challenge—our shortage of everything from energy to housing to child care to family doctors—won’t be fixed by writing cheques (in fact jacking up demand only makes things worse), but it won’t be fixed by mere fiscal restraint either. And young Canadians know it... As Conservative leader Pierre Poilievre started talking to young Canadians about housing, they started to flex their political power. Now that their preference for housing solutions is showing up in the polls, the Liberals are scrambling to catch up. It wasn’t so long ago that political advisors told aspiring politicians they could offer up cash to voters aspiring to home ownership, but real supply-side solutions were untouchable. Then Millennials and Zoomers flipped the script on the NIMBYs practically overnight... Crestview’s October survey of 2,000 Canadians found that as much as 70 percent of Gen Z decided voters are open to “pay for service” health care, a shockingly high number for anyone who grew up learning the gospel of the Canada Health Act."
I still see lots of left wingers claim that underfunding is the problem. Of course, US-style special pleading is the only way to maintain that, given international comparisons
Jack Mintz: B.C.’s real affordability problem is taxes - "Overall, B.C.’s taxes and other own-source revenues (such as fees and royalties) have risen sharply under the NDP. As a share of GDP, they are up from 18 per cent in 2017 to 22.9 per cent this year... But while they have been rising sharply, spending has grown even faster, so provincial debt is up from 14.4 per cent of GDP when the NDP took office to 18.1 per cent last year."
So much for the cope around healthcare being ruined by conservative parties that the BC NDP is really a conservative party
Comparing Performance of Universal Health Care Countries, 2023 - "Canada spends more on health care than the majority of high-income OECD countries with universal health-care systems. After adjustment for “age”, the percentage of the population over 65, it ranks highest for expenditure on health care as a percentage of GDP and ninth highest for health-care expenditure per capita. The availability of medical resources is perhaps one of the most basic requirements for a properly functioning health-care system. Data suggests that Canada has substantially fewer human and capital medical resources than many peer jurisdictions that spend comparable amounts of money on health care. After adjustment for age, it has significantly fewer physicians, somatic-care beds, and psychiatric beds per capita compared to the average of OECD countries included in the study. It ranks close to the average for nurses and ranked ninth for the number of long-term care beds (per 1,000 over the age of 65). While Canada has the third most Gamma cameras (per million population, age-adjusted), it has fewer other medical technologies than the average high-income OECD country with universal health care for which comparable inventory data are available... Canada ranked last (or close to last) on four of four indicators of timeliness of care; and ranked seventh (out of ten) on the indicator measuring the percentage of patients who reported that cost was a barrier to access. When assessing indicators of availability of, access to, and use of resources, it is of critical importance to include some measure of quality and clinical performance in the areas of primary care, acute care, mental health care, cancer care, and patient safety. While Canada does well on five indicators of clinical performance and quality (such as rates of survival for breast, colon, and rectal cancers), its performance on the seven others examined in this study are either no different from the average or in some cases—particularly obstetric traumas—worse. The data examined in this report suggest that there is an imbalance between the value Canadians receive and the relatively high amount of money they spend on their health-care system. Although Canada ranks among the most expensive universal-access health-care systems in the OECD, its performance for availability and access to resources is generally below that of the average OECD country, while its performance for use of resources and quality and clinical performance is mixed."
Damn conservative governments underfunding healthcare!
Brampton hospital advising patients to seek help elsewhere due to high volumes - "the William Osler Health System reported Saturday that the Urgent Care Centre at Peel Memorial is experiencing high patient volume, resulting in extended wait times for patients to see a physician. They also have advised infants aged six months and younger to visit a nearby emergency department instead"
Mia on X - "This article is next-level bonkers. Opens with a sob story about a delusional woman who thinks she’s sexless and, therefore, needs to have her breasts cut off and her chest sculpted into a more masculine shape. But Ontario Health would only cover the $6,500 cost of removing her perfectly healthy breasts and not the additional $3,500 cost of the sculpting. So she had to raise money on GoFundMe. Next, the article plunges into the realm of the truly bizarre, listing all the procedures necessary for a transgender person to become their true authentic self. These include facial feminisation surgery at the cost of $15,000, vocal surgeries, voice training for $150 an hour, and body contouring such as liposuction. Then there’s the inconvenience of there only being three clinics in the whole country willing to create surgical wound cavities out of amputated penises or offering the service of stripping the skin of a mentally ill woman’s forearm and using the tissue to fashion a pseudo-penis that is then attached to her groin. It is suggested that these procedures are “medically necessary” and ought to be covered because they are life-saving care, but no evidence is provided to support this latter claim. But here’s the thing: If your true authentic self requires tens of thousands of dollars worth of surgeries, voice training classes, genital amputation or having a non-functional appendage made out of your forearm sewn onto your groin, maybe, just maybe, it’s not your true authentic self. Maybe you have a serious psychiatric condition that requires psychotherapeutic support. The atrocity euphemistically called “gender-affirming care” is not medicine. It’s a ghoulish crime committed against vulnerable, mentally ill people, and it needs to be consigned to the dustbin of history with lobotomies, not deemed a human right, celebrated, and funded by the Canadian taxpayer."
Damn healthcare costs going up due to greed!
LILLEY: Ford's total health reform package isn't revolutionary but it is substantial - "As for all the talk about filling corporate coffers, the province pays hospitals $663 per cataract surgery right now and the independent centres, yes, some of them are private, will be paid $605 per cataract surgery. So, the cost to the province will be lower, your care will come faster and the quality will be the same. Dr. Anuj Bhargava, the chief of ophthalmology at Ottawa’s Monfort Hospital, also performs surgeries at Herzig Eye Institute, one of the locations that has been approved to start performing surgeries paid for by OHIP. He said at his hospital he gets three to four operating days per month because there is a lack of capacity in the hospital. “This obviously increases our capacity and decreases our waitlist of course,” Bhargava said. That’s a win-win for patients. So too is being able to go to your pharmacist to get prescriptions for issues such as cold sores, pink eye, urinary tract infections, hemorrhoids and hay fever, among others. This change, already in place in other provinces and other parts of the world, will free patients from having to go to the doctor and free up doctors to see other patients about more pressing matters. This kind of change should have happened years ago, but Ontario’s health system has been incredibly resistant to change of any kind. It’s why paramedics have been held back from getting permission to treat more patients who don’t need to go to the hospital. Paramedics in this province aren’t just ambulance drivers, they are highly skilled in providing front-line health care and these changes will help ease the crunch at emergency rooms."
Why are so many of Alberta's rural doctors from South Africa? - "Thirty years ago he faced far fewer barriers to entry than doctors do now, he said. "Back in the good old days of faxes I sent a fax off and they said sure," he said."
Damn conservatives underfunding healthcare!
In order to not be racist, a medical degree from India has to be treated the same as one from Japan, despite fake degrees being a problem in one country but not another. Anti-racism kills, once again
Harry Rakowski: Why do we accept mediocrity in health care? - "We rank fourth in per capita spending, so it isn’t simply a matter of throwing more money at the problem. We need to learn from the successes of other countries with universal access and take advantage of innovation and new technologies that will improve outcomes and lower costs per service. Other countries provide universal health care with a hybrid model of public and private insurance or a choice of competing plans with mandated coverage. Germany, Netherlands, Sweden and Israel all have such universal models with high levels of care and shorter wait times. We also need more resources spent on patient-facing practitioners rather than on administrators. We have a much higher ratio of administrators to patients than Germany without better care and longer wait times. Greater access to primary care can come in the short term from fast-track approval of physicians from countries with high-level training to practice here. We also need longer-term planning to create more medical school and nursing school enrolment and greater use of nurse practitioners. We haven’t yet adopted innovations that other countries have used to decrease wait times. Congested emergency departments can be decanted by more semi-urgent care ambulatory centres open for long hours and triage call centres that can provide virtual care. Earlier hospital discharge models exist that open beds by providing higher-level monitored home care. We need to prepare for the use of AI to better predict the need for interventions and their timing. Israel has an excellent AI-based ER triage system that we have declined to adopt. The responsibility for care lies not simply with providers of care and payers, but with patients themselves. We need to be partners in preventing disease and reducing health-care costs. Our society has increasing levels of obesity, diabetes, preventable cancers, and addictions. Everyone has to take increasing responsibility for their own welfare. They need to be assisted in personalized prevention strategies and access to consultations that guide these strategies and provide counselling that addresses the underlying psycho-social factors that contribute. Preventing disease is far more desirable and less expensive than costly therapy. Governments will continue to provide Band-Aid solutions to chronic and complex problems as long as they aren’t vigorously challenged to do better. They work on short-term solutions that make them look good and avoid the long-term vision and innovation that goes beyond preparing for the next election."
Clearly more money is needed and the problem is conservative governments underfunding healthcare and any private involvement means becoming the US system
