With provinces beginning to re-open after the pandemic shut-down, one of the most pressing issues is how to improve the health-care system so as to be better prepared for a possible second wave.
One health policy expert thinks it’s time to consider reforms that will allow the private health sector to relieve the strain on the public system caused by cancelling elective surgeries and other treatments to free up services for COVID-19 patients.
Rescheduling these procedures will make already long wait times even longer—something that may take years to turn around, says Bacchus Barua, the associate director for health policy studies at the Fraser Institute.
“Provincial ministers have had to make difficult decisions, including the cancellation of thousands of elective surgeries,” Barua said in an interview.
“While it’s important to continue to support all those involved in this difficult situation, it’s becoming increasingly clear that these surgeries are adding to a growing backlog that may take years to address within the confines of our existing health system.”
In British Columbia, 30,000 cancelled surgeries will be rescheduled starting May 18. The provincial government said it will take up to 17 to 24 months to clear the backlog and add a cost of $250 million to the health-care system. And that’s not counting an additional 93,000 people on the wait-list for elective surgeries.
Though other countries have taken the same measures as Canada in putting off elective surgeries during the pandemic, Barua said there are three reasons Canadians should be particularly worried about the health-care system’s current situation.
“First, international data shows that despite ranking amongst the top spenders, we have fewer physicians, beds, and diagnostic imaging technology (MRI and CT scanners) than most other universal health care systems,” he explains.
“Second, Canadians already struggled to address remarkably long wait times before the current crisis. Third, most provinces are struggling with deficits and increasing debt; spending more is simply not a realistic solution.”
A 2018 study by the Fraser Institute that compared the performance of different universal health care systems concluded that, among 28 other OECD countries with universal health care, Canada ranked 26th for physicians, 16th for nurses, and 25th for both acute care beds and psychiatric care beds. The study found that Canada ranked the worst when it came to the number of patients who had to wait two months or more for specialist appointments and four months or more for elective surgeries.
Concerns about the health-care system has some saying the re-opening is happening prematurely, one being Dr. Sandy Buchman, the president of the Canadian Medical Association. At a Senate social affairs committee meeting on May 20, Buchman said reopening is “a gamble” and said Canada’s already “sick” health-care system has been even more derailed by the pandemic.
Arguing that Canada desperately needs more capacity to “conduct more testing and contact tracing” in order to better stabilize the health system, Buchman said the country won’t be adequately prepared come a second wave if certain measures aren’t taken, including dealing with the shortage of personal protective equipment.
Barua said the fact that Canada doesn’t have a strong accompanying private sector like other universal health systems do in countries like Australia, Germany, and Switzerland, puts it at a disadvantage.
These countries “have the private sector as an ally,” he said, and a similar approach in Canada would help address the issues caused or exacerbated by the pandemic.
“First, the private sector can help reduce strain on the public system by treating patients who are willing and able to pay,” he said.
“Second, Canada’s public system can contract services to private clinics in order to treat more patients without investing in expensive infrastructure, which is an approach that was successfully tested during the Saskatchewan Surgical Initiative and is now being considered in British Columbia. Third, the private sector would be able to respond far more dynamically to the needs of patients since it would not be bound by government budgets.”
As the pandemic continues to put an extra burden on Canada’s already unstable health system, considering reform is crucial at this time, Barua said.
“Our health-care workers are doing an incredible job; however, our health-care system has significant challenges ahead,” he said.
“Now is the time to consider policy reform to help patients whose surgeries have been cancelled, as well as those who routinely face long wait times for treatment every year.”