A nurse looks outside while in the intensive care unit at the Humber River Hospital in Toronto on Jan. 25.Nathan Denette/The Canadian Press
During his province’s recent election campaign, Quebec Health Minister Christian Dubé made a point of not promising a family doctor for every Quebecker. His boss, Coalition Avenir Québec Premier François Legault, had made that mistake in 2018, only to be faced with an even bigger doctor shortage four years later.
Oh sure, Mr. Legault tried to spin the numbers in his favour, arguing in one debate this past fall that more Quebeckers had access to a primary-care provider now than in 2018. But he could not deny that the waiting list for a family doctor had grown to 834,000 Quebeckers from less than 500,000 on his watch.
Luckily for the CAQ, voters in Quebec had become so inured to politicians failing to fix their health care system that few blamed Mr. Legault and Mr. Dubé directly.
What Mr. Dubé did promise was an umpteenth structural overhaul of the province’s $75-billion health care system. “We are going to make sure there is less bureaucracy, fewer interventions by the ministry and more decisions taken by managers on the ground and with health care workers,” he said of his plan to create Québec Santé.
Mr. Dubé insisted the new agency would simplify the chain of command from bureaucrats on down to health care workers, leading to a system that is more responsive to patient needs. But Quebec voters could be forgiven for thinking that it all sounded like just more chair-rearranging on the Titanic deck.
After all, what Mr. Dubé described as an innovation was already old news elsewhere. One inspiration for Québec Santé appears to be Ontario Health, which was created by Premier Doug Ford’s government in 2019 with a mandate to “connect, co-ordinate and modernize” the province’s health care system and “make it more efficient so that everyone in Ontario has an opportunity for better health and well-being.”
Such Pollyannish objectives defy reality. Countless structural overhauls have not only not improved the performances of provincial health care systems, but they have arguably made them worse. And they have done little to nothing to shrink bloated bureaucracies with organigrams worthy of a George Orwell novel.
You’d think that, with all those highly paid and credentialed bureaucrats, governments would have all expertise they need in-house. But, no, our bureaucracies are turning more than ever to private consultants, if not to advise them on how to manage the system, to provide cover for their own decisions and shirk accountability by waving a consultant’s report when things go wrong.
To wit, the health ministries in Ontario and Quebec both awarded lucrative sole-source contracts to McKinsey & Co. to advise them on their response to the pandemic. “Our response has benefitted from recent advice from a consultant on international best practices,” the Ontario government responded after the province’s auditor-general criticized its early management of the pandemic. Mr. Legault similarly insisted that McKinsey’s advice “helped us save lives.”
Why anyone would think it would now be a good idea to expand the federal bureaucracy’s oversight of health care in Canada is beyond reason. Yet, that is what Prime Minister Justin Trudeau’s government is proposing. After years of ignoring provincial calls for a big increase in the Canada Health Transfer, federal Health Minister Jean-Yves Duclos this week said Ottawa would be willing to provide more cash – he would not say how much more – “in the spirit of collaborative leadership” if the provinces commit to the establishment of a national health data system.
Ottawa has already moved to set up a national dental care program and continues to promise the creation of a national drug insurance plan and national standards for long-term care. There is little evidence that making federal cash transfers conditional on meeting new federal standards will improve health outcomes. But, you can be pretty sure that it will lead to more bureaucracy.
Overall health care spending in Canada is projected to reach $331-billion this year, or 12.2 per cent of gross domestic product, accounting for nearly double the proportion of Canada’s economy that it did four decades ago. The increase partly reflects better and more expensive procedures and treatments for Canadians, who are living longer than ever. But it is also the result of bureaucratic bloat. The efficiency losses that result are costing us billions that could otherwise go toward providing better care.
More private delivery of publicly funded health care procedures is an obvious, if only partial, solution to improve an underperforming system. But Medicare purists still shudder at the very mention of the idea. So, we instead get more lame attempts to shuffle the deck chairs as our health care system cruises toward its inevitable fate.
Konrad Yakabuski