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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