Same old ideas won't cure crisis in health care
Just days after Alberta announced some modest, yet controversial, health-care reforms, Statistics Canada released new census data illustrating just how daunting the challenges are that lie ahead for our health-care system.
It also illustrates the disconnect between our current health-care policy debates — and what constitutes “bold” or “controversial” — and the sorts of debates that inevitably await us as pressure continues to grow on our health-care system.
On April 22, Alberta Health Minister Jason Copping announced the number of eye surgeries done each year in private surgical facilities will increase by 25 per cent. The hope is that by having private clinics handle more surgeries, hospital capacity will be freed up.
In fact, the 2019 Mackinnon report, which outlines ways in which the province can get more bang for the bucks in all aspects of government spending, recommended more of this approach.
It in no way compromises the principle of universal health care, either. As the minister noted, “a surgery provided under contract … is publicly funded health care, just like in a hospital.”
And while this merely represents a slight expansion of what was already a component of Alberta's health-care system, there was predictable outrage from the Opposition NDP and groups like Friends of Medicare.
Last week's census data, however, should be a major wake-up call for governments.
For example, the number of Canadians aged 85 and older more than doubled since 2001 and is expected to triple by 2046. In fact, that age group is the fastest-growing age group in the country. Meanwhile, when it comes to the working-age population, we now have a larger proportion of people aged 55 to 64 than those aged 15 to 24. That's over a fifth of the population on the verge of retirement.
So as our population ages, and the pool of taxpayers shrinks, there is — or there should be — a growing urgency when it comes to finding efficiencies in what is a stubbornly inefficient health-care system.
A major report last year from the Commonwealth Fund found that although Canada's health-care system ranks higher than the American system (the only comparison we seem to ever make), we actually ranked second-last in a comparison of 11 high-income countries. And this study examined some pretty important metrics: equity, access to care, affordability, outcomes and efficiency.
Logically, we would look to those countries that perform at the top in these areas. Judging from past experience, however, we may not be ready for those conversations.
One of the top-performing countries in the Commonwealth Fund report was the Netherlands, a country that, like Canada, has a universal health-care system. Perhaps this country has some lessons to offer ours.
As it happens, there was a report released last week by the C.D. Howe Institute looking at how the Dutch model could be a cure for what ails Canadian health care. Unfortunately, it feels like the very aspects that make the Dutch system perform so well are virtually unthinkable in the Canadian political context.
Take, for example, the concept of “managed competition.” In the Netherlands, there are competing health-care plans and those are funded through risk-adjusted government vouchers. Remember, this is a country that scores high on equity and access to care, two principles that defenders of Canada's status quo ostensibly cherish.
As the report notes, “competition within a universal coverage system would improve adaptability and allow for care that effectively addresses individual and changing health demands.” That adaptability is going to be crucial as we deal with an increasingly aging population. And yet, it's easy to imagine the outcry against any sort of proposal that would take us down that path.
The reaction to Alberta's announcement on contracting out additional eye surgeries is proof of that. Rather than preparing for future challenges, our health-care debate remains stuck in the past.