A study published in the Canadian Medical Association Journal found that adult COVID-19 patients with disabilities had 36 per cent longer hospital stays and a 77 per cent increased risk of readmission within 30 days.Chris Young/The Canadian Press
The COVID-19 pandemic magnified fractures in Canada’s health care structure that should motivate providers and politicians to search for a stronger model that’s not only more cost effective but also more equitable, panelists said at a recent Globe and Mail forum sponsored by the Canadian Medical Association.
The pandemic highlighted the failings of what is one of the developed world’s most expensive health care systems, said Nadeem Esmail, senior fellow of the Fraser Institute. “We began the pandemic with fewer hospital beds than the vast majority of our peer nations. Despite spending more, we had fewer physicians per thousand population and fewer medical technologies and our hospital system was overwhelmed much faster, forcing us to lock down more aggressively and that had a significant impact on the economy.”
It’s estimated that wait times alone cost Canadians $4.1-billion a year in lost time and productivity. And much of that could be eliminated by emulating the strategies of countries like Sweden, Switzerland, Germany and the Netherlands, he suggested. All of them feature competitive private alternatives to public health care, which help reduce waiting times for elective procedures.
A reset should focus on community-based models that are able to engage with clients and mitigate more serious health conditions.
— Cheryl Prescod, executive director at Black Creek Community Health Centre
“I think we all agree that the system we have is broken,” said CMA president Katharine Smart. “More of the same is not working, so let’s get the right people at the table and get action and not be blocked by our commitment to the status quo.”
A big issue in Canada’s system is that it doesn’t link outcomes and accountability to funding very well, she noted. “That’s why we need to improve our data infrastructure and electronic medical records so we can be tracking how we’re doing. Without data it’s very hard to know the quality of service being provided and what places are doing well, and which aren’t.”
There are also opportunities to reduce wait queues by moving more day surgeries that don’t need all the resources of a hospital into private clinics, “but we have to be careful that we don’t let that conversation derail by assuming that what we’re looking at is creating a market for health care,” she adds. “What we think of in terms of private care in Canada is often an American approach, which is not an example of a health care system we want to emulate. But we do have examples of private delivery of publicly funded services that work well.”
Health care also needs to do more to build trust and confidence among marginalized communities, which were severely impacted by COVID-19, said Cheryl Prescod, executive director at Black Creek Community Health Centre. She cited an example of a caregiver who had to keep working two jobs to support his family and in-laws despite having contracted the virus. He ended up spreading infections to his in-laws, who passed away.
“There are folks whose faith in the health care system is so eroded, they will not go to the hospital before things get so catastrophic that they have to be admitted. A reset should focus on community-based models that are able to engage with clients and mitigate more serious health conditions.”
Home care should also play a bigger role in a revised health care system, said Ottawa-based caregiver and advocate Craig Conoley. “I think we are the hidden backbone of health care and partnerships between health care teams and caregivers were severed due to COVID visitation restrictions.”
Recasting the health care system will take political will and politicians need to recognize that this is a special time, suggested Dante Morra, chief of staff and president of THP Solutions at Trillium Health Partners. “It may not be like at the Olympics, where everyone is cheering, but there are moments where people can come together. I think we’re at a moment where we can agree on what’s not working and what works better elsewhere and that’s a great place to start,” he added. “Step one is to ask what’s the best way to use our universal dollars and step two is copy somebody who’s better than us. And we have to have hard conversations about choice, because choice is important.”
An example of a more effective solution is bundled care, he said, citing a cardiac program at Trillium Health Partners in which home health care workers will be doing follow-up care work as part of the hospital team from the time of the procedure. The approach results in a reduction in postoperative stay in hospital and a significant reduction in readmission rates. “The patients in the program got better outcomes and less infections because they were caught earlier, and it cost a lot less,” he explained.
Technology will also play an increasing role in future health care, and that presents opportunities for Canadian research and development companies to help solve problems and turn into global winners. “The result could be not only savings and better outcomes, but also significant economic growth,” Dr. Morra said.
Ultimately, he believes, “by copying what others have proved works better and using our talent to solve our problems, there’s a great future ahead for Canada.”