Opinion | Saturday’s Debate: Does COVID Show Canadian Healthcare Should Have More Private Competition?


Gwyn morgan

Retired business leader

The coronavirus hit Canada in March 2020. By the time the first wave had subsided in the summer, hundreds of thousands of scheduled surgeries had been postponed. But before that massive backlog could be reduced, a second and then a third wave of the virus struck, increasing the backlog by thousands more. Adding to the clinical risk of these surgical delays is the mental health impact of living with aggressive conditions, such as cancer.

Just when hospital wards became available for regular surgeries last spring, a fourth wave driven by the Delta variant overwhelmed ICUs in Quebec and Ontario before moving west to sink Saskatchewan and Alberta hospitals in their crises. current.

The pandemic will finally go away. While deaths from COVID-19 can be counted, the number of deaths from all those delayed surgeries is virtually impossible to determine, as each patient’s path of grief is different.

But given the hundreds of thousands who experienced physical decline and mental stress due to treatment delays, that number seems almost certain to be much higher than COVID deaths. The COVID deaths were clearly a severe blow, but so were the physical costs, increased stress, and in some cases the accelerated death of people with other serious conditions who were denied access to medical care. “

The real tragedy for families who lost loved ones to delays in treatment caused by COVID is that those deaths occurred because our health care system was woefully less prepared than in other developed countries. Canada is the only country that entered the pandemic without unused hospital capacity and with long waiting lists.

A 2020 Fraser Institute report Comparing 28 countries’ performance with universal healthcare, it was found that, despite having the second highest per capita healthcare spending, Canada ranked last in timely care, with the longest waiting lists.

Canada ranked second to last in hospital beds per capita, helping to explain why so many surgical patients were displaced by COVID patients. Our other health care resources have also steadily declined. Out of 28 countries, we are ranked 26th in the number of physicians per capita and we also rank last in diagnostic equipment such as MRI and CT scanners.

How was our health care system allowed to slip into this sad and dangerous state? As the COVID crisis wears off, that’s a question that grieving Canadians should demand an answer to. Given that we are one rung from the top in the Fraser Institute’s 28-country rankings, the answer is not a lack of funding. So what is that?

Of those 28, Canada is the only one that prohibits private sector participation in the provision of health services. Can you imagine if you could only get food from a government store or a vehicle from a single government company? Quality? Service? Innovation? Not likely! Gradual decline in quality, customer service, and supply? Almost sure. And the result? Rationing through waiting lists.

Prime ministers, prime ministers, and health administrators have known for years that our sclerotic government-run monopoly system suffers from the double affliction of unsustainable cost growth and ever-lengthening waiting lists. Unions and other interests opposed to private clinics and hospitals vigorously perpetuate the myth that Canada has the “best health system in the world.” But the comparison of 28 countries clearly shows the opposite.

Deep-seated fear of private sector involvement affected the recent federal election campaign when liberal candidate Chrystia Freeland posted a video on Twitter of Erin O’Toole declaring that she would allow the provinces to “experiment with real health care reform, including private for-profit and non-profit options. “Twitter later marked Freeland’s post as” manipulated media “because it omitted O’Toole’s words” within universal health care. “

Liberal leader Justin Trudeau repeatedly ignored that clarification, saying “Erin O’Toole confirmed he wants to bring private and for-profit healthcare to Canada …” It is ironic, given that the Liberals’ campaign focuses on the dangers of misinformation on the internet, which Trudeau’s use of Freeland’s deliberate deception helped liberals return to power.

Canada’s doctors, nurses, and other healthcare workers are world-class and very dedicated. They have continually risked their own health by doing everything humanly possible to balance the needs of COVID and non-COVID patients, even when faced with a flagrant lack of facilities.

They deserve our support, consideration and admiration. But once the pandemic has passed, Canadians should demand that the dangerous and dysfunctional health care system of Canada’s government monopoly be opened up to competition from the private sector, as in any other country in the world.

Gwyn morgan is a retired Canadian business leader who has been a director of five global corporations.


Drs. Danyaal Raza and Danielle Martin

Family doctors

If there is one thing that an infectious disease pandemic teaches us, it is that an “each person for themselves” approach to health puts us all at risk.

Over the past 18 months we have learned that the actions of each one of us have implications for the health of all. Due to our public health system, few Canadians worry about the hospital bills associated with getting seriously ill. But in the absence of medicare the costs of ICU stays it would ruin everyone but the richest. In this pandemic, those costs would have been disproportionately borne by those least able to pay.

A vital way out of the dire impacts of a crisis on the healthcare system is centralize our resources and assign them to the areas of greatest need. Imagine if, at the height of our successive COVID waves, healthcare workers had been working in private hospitals providing elective care to wealthy Canadians, rather than working where they were needed most.

Now, as we contemplate the long and slow rebuilding of our health systems in the face of exhausted staff and long waiting lists, this is not the time to put equity aside. Also, ignoring equity doesn’t work. Private hospitals and clinics I don’t want to take care of sick people. Proponents of private healthcare solutions would do well to analyze what private hospitals have contributed to pandemic efforts.

In March 2020, the British NHS entered wide-ranging agreements with the private hospital sector to provide hospital care to COVID patients and elective care to other public patients. A year later between £ 2bn and £ 5bn of public funds were spent, while the public system remained overwhelmed by the attention of COVID. Publicly funded elective care in private hospitals actually declined, while almost no COVID patients were treated. In fact, private hospitals provided only 0.08 percent of COVID care, offering little relief at enormous cost.

Similary, In New York City, at the height of the first wave When public hospitals were overwhelmed with COVID cases and dealing with staff shortages, private hospitals described a “sense of calm” and one doctor noted that “nothing serious is happening here.”

Therefore, private for-profit entities are unlikely to do the heavy lifting of caring for our sickest patients. But can they help cut wait times for some of the “simpler” care, now that we are faced with huge delays in hip and knee surgeries, for example? Should we allow patients to pay out of pocket to access services like these? The consequences of such a move could be devastating for hospitals.

Like health systems around the world, Canada’s hospitals and clinics are facing unprecedented stress and their staff are on the brink of exhaustion. In this context, privately financed health services would remove doctors and nurses from the public system, which are already in short supply and are about to become so. For the vast majority of Canadians who rely on the public system, care is almost certain to get worse.

As healthcare workers, we experienced the frustration of patients whose surgeries or imaging were delayed or canceled because those resources were being directed to the sickest people.

But let’s tackle the backlog in a way that doesn’t have unforeseen consequences. For example, we can reduce waits referrals to specialists if we help them operate in team-based models of care linked to “single-door” referrals. We can also address wait times increasing telephone or email consultations between family physicians and specialists, eliminating the need for patients to wait to see the specialist themselves, often receiving advice within a few days.

Even before COVID-19, Medicare health services, like hospitals, received less public funding compared to our international peers. Countless other areas of care currently outside of Medicare, such as prescription drugs, psychology, dentistry, long-term care, and home care, already exist in a two-tier system. Instead of resorting to private solutions to public problems, we must strengthen public health care with programs that improve the health of our population, such as national pharmaceutical care.

COVID-19 has brought home the reality that the only rational way to structure a healthcare system is to direct care where it is needed most, rather than to those who can best afford it. If we turn our backs on that principle now, we really won’t have learned anything at all.

Dr. Danyaal Raza is a family physician at Unity Health Toronto, an assistant professor at the University of Toronto, and a past chairman of the board of Canadian Doctors for Medicare. Dr. Danielle Martin is a family physician at Women’s College Hospital and chair of the Department of Family and Community Medicine at the University of Toronto Temerty School of Medicine.


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