Discussions related to the strengths and weaknesses of the American health care system abound. When discussing the latter, some may argue that the American system should more closely mirror that of its northern neighbor, one that is described as publicly funded and that allegedly provides “free” and readily available health service to all citizens regardless of social status or financial means. Sadly, there is little truth in the above description. For those interested, here is a forthright description of the current unfortunate state of Canada’s so-called health care system.
Canada’s health care system is in a state of potentially terminal decline. In our “universal public health care system,” one in five Canadians do not have a family physician. Preventive medicine? Good luck. Some discouraged citizens have turned to providers of private (and notionally illegal) “concierge medicine” in an expensive but ultimately fruitless attempt to ensure appropriate access to services. And absent family medicine care, patients flood the decreasing number of emergency departments that remain open, adding to their states of insufferable gridlock. It is estimated that at least 15,000 patients annually die while awaiting care in Canadian emergency departments.
Beyond emergency care, Canada’s public health system does not provide reasonable access to a broad array of essential clinical services. Parents of a child suffering from a mental health disorder will find it extremely difficult to navigate the system so as to access the care their child needs. A growing number of patients choose to bypass months-long waiting lists for much-needed CT or MRI scans by paying private Canadian providers to perform the test within days. Individuals with debilitating hip or knee pain increasingly seek orthopedic surgery in Canadian private surgical centers, or in the US or Mexico. There is an epidemic of opioid-related deaths across Canada, for which there are limited prevention programs that vary widely from province to province, none of which have proven to be effective. And cancer care? Patients can wait many weeks to see an oncologist for a diagnosed malignancy, and then many weeks later for radiotherapy or surgery, if required. Some provinces have resorted to sending their patients to the United States for urgent cancer radiotherapy.
Programs to early identify “frail elders,” so that interventions can be undertaken to prevent hospital admissions, are rare. So such individuals often end up in emergency rooms and are admitted to hospital. Families and health care providers then struggle to access home care or visiting nursing or appropriate long-term accommodation for these patients, in part because these essential community services generally exist as silos, imperfectly integrated with acute care, and administratively unaccountable. So these patients become “bed blockers,” lying in hospital rooms, receiving inadequate physiotherapy, progressively deteriorating, losing any capacity to be discharged to a home environment, and occupying beds that could be used to admit patients from backed-up emergency rooms. By the way, in the later years of your arc of life, how would you feel if you were disparagingly described as a “bed blocker”?
Many health care professionals, stressed to the point of burnout, are leaving their positions and their patients. Canadians continue to reflect on the lessons learned, but not acted upon, from the recent pandemic, including those related to the poor organization, governance, accountability, and functioning of Canada’s chronic care system. And how is quality of care assessed and assured in Canada’s system? Don’t even go there.
Finally, the key narrative about Canada’s health care system, that it is publicly funded, is false. It is estimated that Canadians pay at least 30 percent of standard health care costs privately or through privately purchased insurance. In addition, the growth of for-profit health care, notionally illegal in Canada, continues to be monumental, while being ignored by governments. And one can only estimate how many billions of dollars Canadians pay for out-of-country care. Finally, philanthropy is a poorly acknowledged but key contributor to Canada’s “public” health care system. As just one example, no hospital expansion or renewal or major capital project will be approved in Canada until a significant proportion of the costs have been raised privately.
Robert Allan Bear is a physician and health care consultant.
