Guest column: Canadians deserve to know if healthcare dollars are being spent wisely

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The results of Canada’s federal elections had barely been counted when prime ministers resumed their well-worn demands for more federal money for health care.

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Rather than thank Ottawa for the billions it has already provided to combat COVID-19 or call for short-term funding related to the pandemic, the ritual chorus seeks increasing amounts of money over the next few decades.

Of course, the need for more money certainly feels urgent right now.

Intensive care is on the brink of collapse in Alberta and Saskatchewan, and health officials are preparing to make painful decisions about triage of patients as COVID-19 infections rise. Several provinces are struggling even to staff their hospitals after nearly two years of burnout-inducing front-line health care workers.

However, the multibillion-dollar calls from prime ministers have been for long-term unconditional funding, well beyond the scope of the current crisis.

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But they have not been clear about how the new money would be used. It’s completely reasonable to ask them to explain themselves, especially since spending more on healthcare doesn’t automatically mean better health outcomes.

In a recent study, CIBC economists Benjamin Tal and Andrew Grantham found that COVID-related hospitalizations per million people were four times higher in the US and five times higher in Britain than in early Canada. of 2021.

“However, as we all surely remember, the hospital system in Canada during the second wave was on the brink of ingenuity,” they write. “Simply put, we are reaching capacity at levels that many other countries consider acceptable.” They conclude that Canadian hospitals need more money.

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But this is only part of the story. While the US is well known for having much higher healthcare spending than any other country, both the UK and Israel spend significantly less than Canada and yet neither of them came close to peaking. in hospital capacity. So the problem may not just be a lack of funds, but how our health care dollars are being allocated.

One reason provincial governments prefer to harass Ottawa rather than focus on using the funds they have more efficiently is that passing the buck is painless.

As Canadian health economist Bob Evans says, “Every health care cost is someone’s income,” that is, controlling or reducing health care costs means controlling or cutting doctor and nurse salaries, hospital budgets and the profits of pharmaceutical companies.

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It is much easier politically for the provinces to demand more funds than to enter into conflict with such powerful interests.

But there is also a deeper reason. The provinces and the federal government may simply not have the data to assess their healthcare spending, even if they wanted to. If they have the data, they certainly keep their evaluations hidden.

This is not by accident. The smartest leaders among key stakeholders have no interest in such data, because they may fear that it will lead to results that will embarrass them and turn public opinion against them, possibly in ways that reduce their income or autonomy.

For decades, some of the most important data showing healthcare waste and inefficiency has looked at variations between small geographic areas: “zip code medicine.”

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These variations, which are the continuing theme of the Dartmouth Health Atlas, consistently show, while some parts of the US spend two to three times more on healthcare than others, key health indicators such as primary care for diabetic patients and postoperative complications. they are not correlated.

A recent study by leading US health economists concluded that these variations were not due to differences in patient needs; instead, they were more closely associated with clinicians’ beliefs that “were not supported by clinical evidence.”

The specific examples they studied suggested that 12 to 35 percent of this healthcare spending was unjustified.

Canadians are rightly proud that our healthcare industry is not nearly as expensive or inequitable as the United States. But we are not immune. A decade-long study looked at heart attack treatments in Canada and found a three-fold difference between healthcare regions with no obvious difference in post-surgical mortality at 30 days.

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Unfortunately, no one has updated this study, in part because the necessary data is simply not available. We could get a better value for our money in healthcare if we knew more.

Before the federal government signs more multi-million dollar checks to the provinces with no strings attached, Canadians deserve to know why the additional investment is needed, how it will be spent, and whether after all this time our money has been well spent.

Michael Wolfson is a former deputy chief statistician at Statistics Canada and a fellow at the University of Ottawa Center for Health Law, Policy and Ethics.