Can we afford health reforms after pandemic?

Many extra billions will be needed, Jason M. Sutherland and PG Forest say.

COVID has laid bare a number of critical shortcomings of our provinces' health-care services.

Avoidable deaths in longterm care focused overdue attention on how provinces organize and fund housing and health care for elderly residents with health-care needs. Access to hospital-based care was curtailed and restricted to the critically ill, revealing the limited capacity of the health system, especially for intensive and urgent care.

The disease burden of the pandemic in vulnerable and racialized populations cruelly exposed long and conveniently ignored disparities.

Finally, when hundreds of thousands of workers lost their supplemental insurance coverage at the same time as their jobs, COVID highlighted our precarious access to important types of health care.

Now, with a lessening risk of COVID transmission underway due to vaccine proliferation, provinces face a surge in demand for “core” health-care services. Wait lists for planned surgeries are growing in many provinces. Governments on tight budgets prepare for a steep increase in health costs to catch up with accumulated demand.

In the United Kingdom, the London School of Economics is advocating for a minimum four per cent annual increases in health-care spending to maintain the public system. If the same is roughly true in Canada, government spending on health care would need to increase by the same amount, or almost $7 billion in the first year, only to maintain the status quo. This is nearly twice the yearly budget increase forecasted by the Canadian Institute of Health Information in its most recent projections of provincial health expenditures.

Yet the public's expectations are not only that full access to hospitals and physicians resume and even improve after COVID, but also that solutions be found for crucial issues such as health inequities, long-term care quality and widely available digital or virtual health care. Conditions that led to the transmission of COVID within and between long-term care residences will mean changing the physical layouts of buildings.

Contracts with private and not-for-profit long-term care residences will also need to be rewritten to increase the wages of support workers obligated to patch several jobs together to make ends meet.

Elsewhere, the harms associated with public health orders to self-isolate have contributed to increased stress and isolation. This is causing flare-ups of anxiety and depression and resulting in new demand for mental health-care services.

The arrival of widespread video-based physician consultations highlights the yawning absence of accessible medical records that travel with the patient rather than staying with individual providers. In spite of massive federal investments, provinces are still very far from this, and significant investments will be needed to finish the job.

There are so many different calls for the health delivery system to be reformed or enhanced in the POST-COVID era that it's difficult to get a precise definition of a common national agenda. What is clear is that even if there is no consensus on what this would look like, from the taxpayer and government perspective, making health care different would take lots of money.

The exact price tag is unknown, but the amount could be as much as an additional $15 billion to $20 billion per year for several years, should provinces and territories elect to proceed with serious reforms. Less would not pay for expanding the basket of publicly funded services to include drugs or mental health or better longterm care. Less would not pay for building health technologies that make it possible for health-care providers to access people's health and social care information in any setting. Less would not let us address long-standing injustices and live true to our proclaimed ideal of equity and shared wellness.

In the end, high visibility targets for reform such as pharmacare or mental health will be fighting for the few dollars that remain after paying for hospitals and physicians, rather than getting the billions they need for meaningful and sustainable changes. Mere adjustments to the Canada Health Transfer will not suffice. Without access to expanded sources of funding, provinces and territories will be unable to initiate the major and expensive reforms that the public is calling for. While the healthy majority might be unaware of the lack of change, those who have complex health and social needs will feel underserved and a historical opportunity will be missed. Jason M. Sutherland is a professor in the Centre for Health Services and Policy Research at the University of British Columbia; Pierre-gerlier (PG) Forest is the director of the School of Public Policy at the University of Calgary.