By Hugh Holland
The media is full of analysis about “Canada’s health care crisis”. But in the midst of the bad stories, let’s not forget the many more good stories. I am now near the end of the 12-week recovery period after open heart surgery, and I can say without hesitation that I am very thankful for the excellent care I received throughout the process, from the accurate diagnosis here in Huntsville to the timely surgery at the Southlake Regional Hospital in Newmarket, to the post-operative follow up back here in Huntsville.
Full disclosure. I am by no means an expert on anything medical, but it seems to me the bad stories are almost exclusively system management failures rather than medical failures.
There is an adage that says, “if you can’t measure it, you can’t improve it”. But measuring health care systems involves a complex mix of inputs (including dollars), and outcomes (all the way from ER and surgical wait times to life expectancy). For example, the following chart shows the UK ranking from #1 to # 18, and Canada ranking from #10 to #30. It’s important to understand the following:
- The listed countries all have good systems. There are only small differences in various attributes.
- The most dollars do not always produce the best outcomes.
- All systems have some elements of public and private care, hopefully, tailored to their situation.
- The US is the biggest outlier with the highest cost and the lowest life expectancy. But certainly, if you can afford good insurance in the US, you can get excellent health care.
- Notwithstanding the above, we can all learn from each other.
| Commonwealth 2014 – 11 countries | Bloomberg 2014 – 51 countries | % of GDP (Bloomberg) | $ per capita (OECD) | WHO 2000 – 191 countries | Life Expectancy Rank – Years | |
| UK | 1 | 10 | 9.4 | 3,403 | 18 | 28 – 81 |
| Switzerland | 2 | 15 | 11.4 | 5,643 | 20 | 10 – 82.8 |
| Sweden | 3 | 19 | 9.7 | 3,924 | 23 | 8 – 83 |
| Australia | 4 | 6 | 9.1 | 3,800 | 32 | 9 – 83 |
| Germany | 5 | 23 | 11.0 | 4,495 | 25 | 22 – 81 |
| Netherlands | 5 | 40 | 17.0 | 5,099 | 17 | 18 – 81.5 |
| Norway | 7 | 11 | 11.0 | 5,669 | 11 | 13 – 82.1 |
| New Zealand | 7 | 3,182 | 41 | 17 – 81.5 | ||
| France | 9 | 8 | 11.0 | 4,118 | 1 | 17 – 81.5 |
| Canada | 10 | 21 | 11.0 | 4,522 | 30 | 11 – 82.5 |
| USA | 11 | 44 | 17.2 | 8,508 | 37 | 36 – 79.8 |
| Japan | Not ranked | 4 | 10.7 | 4,752 (BB) | 10 | 1 – 86.2 |
If there is a crisis, it is not unique to Ontario or Canada. It is global and it should not be surprising. The two biggest causes are a general failure to act on readily available demographic data and the highly contagious COVID-19 virus.
2020 was the midpoint of the retirement age for the Baby Boomers, the biggest demographic cohort in history. The baby-boom generation was born between 1946 and 1964, following WW 2. Those people were due to retire at age 65 between 2011 and 2029. The mid-point was 1955 and people born in 1955 were due to retire in 2020. Those retirements included a lot of experienced doctors and nurses precisely when they were needed to deal with the increasing health care needs of their own aging cohort.
This demographic phenomenon is present in much of the world including North America, Europe, China, Japan, and South Korea. The shortage of doctors and nurses is affecting both public and private systems.
Then in 2020, precisely at the midpoint of the massive Baby Boomer retirement, COVID-19 came along and amplified the crisis that was already well underway. Globally, most of the 600 million Covid cases to date (4 million cases in Canada) have visited a health care facility at some point.
I am a capitalist, but that is not to say that unfettered capitalism is best for every application. Facts do not support the myth that employees of large private companies work harder or smarter than public employees. Good people are good people no matter where they work. The US example shows that private health care systems can cost more to cover their large sales and accounting bureaucracies, shareholder dividends, and the $15 million average compensation for the CEO at large US private Health Insurance Companies. That’s enough to pay 65 US doctors or 200 US nurses. But that is not to say there is not a role for private care in a fair and publicly funded system. The Shouldice Clinic is a good example.
So, what is the answer? Obviously, the long-term answer is better long-term planning. Ontario just announced some structural reforms that should help to free up space in overcrowded hospitals and reduce wait times for emergencies and surgeries; to train, accredit and hire more staff, to allow paramedics to provide more forms of care; and get long-term care patients out of increasingly technical acute care hospitals. All of that will likely need more money.
Several Premiers are currently meeting in Nova Scotia to try to come up with some solutions. More money may be required during the baby boomer bubble. And no doubt the provinces would prefer the feds take the heat for finding that money through other cuts or taxes. Given the differences in GDP per capita with Alberta at $80,905 and Nova Scotia at $47,837, perhaps some clearly identified adjustment to interprovincial equalization payments may be the fairest and most flexible way to fund the bubble. Alberta has provided most of the equalization funds in recent years, but for many years before that, Ontario provided the equalization funds.
Here are a few more ideas that should be on the list: Shifting more emphasis to prevention rather than cure, returning to the education, understanding, and discipline of earlier days around the public health benefits of vaccination, and recognizing the growing connection between climate change and health.
One thing is crystal clear, frontline workers should not be abused for system management failures or for the negative impact of crazy conspiracy theories.
Hugh Holland
Hugh Holland is a retired engineering and manufacturing executive now living in Huntsville, Ontario.
References
Myth 5: The private sector is more efficient than the public sector | New Internationalist
List of countries by total health expenditure per capita – Wikipedia
2022 US Doctor Shortage: What You Need to Know (leveragerx.com)
I can solve China’s doctor shortage. Here’s how. – Consult Me Daily
Germany’s doctor shortage: Can studying medicine abroad help? (umultirank.org)
Doctor shortage contributed to Japan’s slow vaccine rollout: Professor (cnbc.com)
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Jane McNamara; Some very good points, your experience is both valuable and credible. I understand the need of for-profit/public, non-profit mix. Even Denmark realized that full socialism was not possible. However, I take issue with the percentage division and the quantity and quality of regulatory supervision and oversight of spending, programming, and service. One thing Cons do in “cutting red tape” is to remove safeguards that were put in place for a Reason; their reliance on the ethical performance of for-profits is naive.
The Ford Government’s recent comments on Ontarians OHIP card still getting them services is smoke screen to where our taxpayer dollars go -into the public system Or into the investment coffers of stock market players, which under the guise of better management is nonsense.
It is virtually impossible to credit Ford with any fiscal conservation when his government blows 1 billion on freebies with license stickers. How much planning did that take?
And short and long range planning is what is needed for healthcare – I do not see the Ford government as having that capacity, understanding, knowledge, or experience – let alone the desire and will to do so.
My opinions are MINE and I will not use “all” or “we” because I do not speak for everyone.
I’m a retired RN (Dec 2021) w/ 29 years of Canadian service I fully agree w/ a two-tiered health care system AND why not? Hopefully nurses will leave one tier for another tier because I know how disgusting bedside nursing salaries can be AND the “considered” norm for the female dominated nursing profession. I began my nursing career w/ $17.00 per hr., however, male hydro worker fresh out of high school was paid $35.00 per hr!
During the last decade of my nursing (BScN) career I was employed as a “fly in fly out” northern “outpost” nurse. After I “fly into community” ironically I’m automatically authorized under the “expanded scope of practice” medical directives umbrella allowing me to perform PAP exams, immunize populations (with no prior public health experience), suture (my favourite), dispense meds from a well stocked pharmacy (every northern FN + Inuit community has a well stocked pharmacy), treat minor to major illnesses, back slab (cast), deliver babies, perform x-rays, draw blood, and so on+ PLUS no F/T doctors in northern FN + Inuit communities. When I need to consult w/ the “on call” doctor I’ll call the doctor BUT as soon as I “fly out” I NEED to call a doctor for “a Tylenol” (over the counter med) order … insane! The health care system’s paternalistic medical model requires an immediate overhaul!
FACT: Should’ve been overhauled after Mike Harris (22nd Premier of ON) called nurses “hoola hoop dancers” and we left Canada in “droves” for Texas!
My experience in LTC; Gov’t forcing elderly into LTC via Gov’t LTC branch CCAC isn’t necessary.
My experience in hospitals; top heavy Administration isn’t necessary.
My nursing experiences thrust autonomy into the forefront; “MY body “MY choice” “MY right” and “MY political choice including MY immunization profile” is personal + private AND not up for political NOR public debate!
FACT: Over the past two+ years Public Health officials have failed on so many levels AND wasted my tax dollars (ONE billion+ for PPE blunders) and I feel those PH officials should be replaced “stat!”
FACT: MD Tam’s personal blunders + failures cost me (Canadian tax payer) 1/2 a billion AND yet MD Tam has been awarded by the Liberal Gov’t w/ a salary increase in 2022 ($325,000.00) … Vital tax dollars LOST to the health care system.
FACT: ONE billion+ annually to STATE funded Media (CBC)
FACT: ONE million provincially to Libraries for Drag Queen Story hour (based on City of Calgary Library spending of $72,000.00 and multiplying that amt for every Library in AB hosting Drag Queen Story hour) FACT: PRIDE flags decorating every street for Annual PRIDE Season (municipal tax dollars) along w/ Transgender Surgeries BEFORE non Transgender Surgeries … Monies generated by “hard working” Canadians NOT being utilized at the municipal health care bedside.
FACT: Open as many hospital beds you want but a bed without a nurse IS furniture! Increase salaries substantially TODAY Increase FT opportunities Increase educational opportunities … Grow YOUR Canadian nurse AND hire EVERY new grad TODAY and RE HIRE every nurse AND health care worker YOU threw out of the health care system over the past two years!
Good Article Mr Holland it reveals many of the complexities are health care system has to face.
Ask someone who has suffered a catastrophic accident what there experience was like receiving adequate care and accessing services. In Ontario.
I have first hand experience and I can tell you the access to services outside the GTA is very limited . So we have a system that helps some regions while leaving other areas without adequate services. Mr Holland is accurate in saying that every govt in the last 20 years has ignored the impact this large segment of the population would have on our strained health care system. They should have hired every nurse who graduated over that time frame.
Without adequate personnel and facilities how will they rectify years of neglect ? By forcing all of us to suffer needlessly. Could this be due to all the elected officials who chose to ignore all the warnings? BTW how many recommendations were put in place after the Romanow report was completed? Ironically none of the recommendations were properly addressed after the cross country consultation process.
So in closing they were all well aware of problems and chose to do little or nothing to address the shortcomings listed in this extensive support which is sitting on a shelf somewhere in Ottawa collecting dust.
Let’s spend 50 million on a comprehensive report and ignore all the findings.
Thank you Mr. Holland for a bigger picture look at the issue of healthcare in Canada.
Points of agreement that I emphasize are:
1] the “general failure to act on readily available demographic data”. Toronto Star did an excellent job of keeping that front and centre during the pandemic.
2] In the US, “private healthcare systems can cost more to cover their large sales and accounting bureaucracies …..”. If what I read is true, there is a move towards a single payer system in some areas of the states to better bring those costs under control.
3] shifting the emphasis to prevention rather than cure. One Huge Advance in this area during my lifetime was made by the Pierre Elliot Trudeau government. Marc Lalonde’s publication, “A New Perspective on the Health of Canadians: a working document” (April 1974) did much to pay attention to data.
Later progress has been made with the “Social Determinants of Health”, with a greater holistic lens.
4] there have been additional costs due to the strides in technological Equipment for assessment and treatment (e.g. scans). This adds to the BB cost numbers. Activity centres do much to help keep seniors – physical fitness, mental acuity, and socialization, especially those which are affordable.
5] “People” are treated in healthcare, not widgits, car parts, the number of posts on social media – which I suggest do not allow for all outcomes to be readily measured (think of the old time-motion studies and the very real limits of a “systems approach” to human services).
Currently, the uncredible (my word) Conrad Black is attempting a similar article. Of interest, he mentions the difficulty in navigating the health care system. I suggest this result has in part come about by:
1] the loss of Case Managers in the Community Care System, with time to actually provide “home visits” (this started in the Mike Harris years folks,– sorry, I know you are tired of hearing about this again – but true in my experience)
2] We too experienced a positive experience – my husband had 2 knees replaced over 2 years, during COVID (no mean feat). The system then had an MS Navigator (RNs, Musculo-Skeletal Navigator). These were experienced RNs, a phone call away, pre & post-op. Their expertise and accessibility meant we avoided ER/outpatients/walk-in clinics & Dr.’s office). This position was indeed and could be threatened by the Ford Conservative government cuts.
I’m sure Black likely knows of for-profits who opportunely sell a similar role navigating the LTC system, if the person needing the assistance can pay the company fees for their services. (a role once performed in the non-profit system by Community Case Managers, Discharge Planners).
Doug Ford seems to be salivating at the thought of repeating the years of Mike Harris, and I think that is why he is visiting counterparts in the Maritimes – to sell his own “good news” story – the only one he knows.
An excellent, well balanced article Hugh.
In the mid-90s, I heard Dr. David Foot – a Canadian economist and demographer – speak at a conference. As I recall, he was promoting a book he’d written called, ‘Boom, Bust and Echo’ which posited that demographics is the key to understanding the past and forecasting the future. I think that as a society, we do a poor job of both. Since then he has contributed much more toward understanding that demographics are crucially important because they provide a broad understanding of the different characteristics of a population.
In fact, Dr. Foot contends that demographics explains two-thirds of everything — whether the subject is business planning, marketing, human resources, career planning, corporate organization, the stock market, housing, education, health, recreation, leisure, and social and global trends. He made a compelling argument for it then and in subsequent publications.
In my humble opinion your article makes a very compelling argument for paying close attention both in general and specifically as demographics relate to the tsunami of baby boomers affecting society in unprecedented ways now and into the future.