A wake-up call for health care
The United States’ comprehensively botched response to COVID-19 has brought on an outburst of pride and relief north of the border. Social media is full of grateful stories about seamless hip replacements, vanquished tumours, and all sorts of other modern medical miracles performed in properly run hospitals that don’t leave any of their patients financially crippled.
It makes for very frustrating reading.
That every citizen should receive swift, expert, compassionate medical care at or near zero out- of- pocket cost is a bedrock assumption of every developed country in the world except the one to which we happen to live next door. If we somehow didn’t live next door to that system, Canada’s health-care conversations would be very different.
The notion that any private- sector service delivery or extra “tier” sends us hurtling down a sewer toward “American-style health care” would be considered absurd. These are common features of other very high- functioning health-care systems. And we would likely focus more on the fact that, relative to similar health- care systems, ours is more than anything else average.
Compared to other OECD countries, Canada fares somewhat better than average on measures such as surgical waiting times, the share of medical costs paid out of pocket, mortality from acute myocardial infarction and colon cancer survival. We have slightly fewer doctors than average. We are the worst in the OECD when it comes to obstetric trauma caused by instruments. And when it comes to the very basic measure of hospital beds per capita, only three countries in the OECD fare worse than Canada. Two are Mexico and Chile.
Italy, with 25 per cent more hospital beds per capita than Canada, is staggering under the weight of the COVID-19 pandemic.
The number of intensive care beds per capita is a more important measure, and it is difficult to find strictly comparable numbers. But studies suggest
Canada is in roughly the same league as Italy — and that countries like Belgium and Germany are leaving us in the dust. Crucially, a 2016 report from the Canadian Institute for Health Information notes that regional disparities are as large as national ones. It found Newfoundland has 21.8 adult ICU beds per 1,000 population — in the same league as Germany and Belgium. Alberta’s 9.8 per 100,000 is significantly below Italy.
All of which is to say smugness, complacency and gratitude are contraindicated. Indeed, some who work in the health- care system seem far less confident than the people who use it that it’s up to the task of fighting this pandemic.
“In the absence of makeshift tent hospitals and the cancellation of all non- urgent admissions and surgeries, a coronavirus pandemic risks exhausting our system’s bed capacity within weeks,” hospital physician Richard Osborne warned in the Toronto Star this week. Late last month, Alan Drummond of the Canadian Association of Emergency Physicians stressed that many lessons had been learned from the 2003 SARS outbreak. But many Canadian hospitals are already operating at or over capacity, he noted.
A 2017 study modelled the effects of a pandemic on the health- care system in Canadian census metropolitan areas. Without a vaccine available, it estimated minimum peak ICU demand, as a percentage of capacity, at between 31 per cent ( in Thunder Bay, Ont.) and at 98 per cent ( in St. Catharines, Ont.). It estimated the maximum peak demand in those cities was 78 per cent and 243 per cent of capacity, respectively.
“We can’t function in a mild flu season. What are we going to do if there is a major pandemic?” Drummond asked, warning of the prospect of “rationing … care and doctors making the decision of who lives and dies.”
If Canada escapes COVID- 19 relatively unscathed, all this ought to serve as a warning: Canada’s health- care system should, can and in future may well have to be much better to avoid disaster. That would be something for which to be appropriately grateful — because if the worst should occur, it’s not a warning we will have any opportunity to ignore.