The Globe & Mail ran a ten part series this May on how to improve health care in Canada, a topic of some interest for this blog. The timing of this set of articles is important. The provincial premiers, who are constitutionally bound to make policy for and ultimately pay for public healthcare, are demanding a new deal with the federal government. As health costs increase at a rate greater than inflation (and have exploded during Covid!), the proportion of costs supported by the federal government has declined. The federal government has been generous and reasonably effective during Covid but their response to the provinces has been to wait until the emergency is over to deal with the long term issues. This will likely happen in the next year or so. Though the premiers are united and have a good case for greater spending, they are basically looking for the federal government to raise taxes while the provincial governments receive credit for fixing a problem that voters care about. The proposals in the Globe & Mail series could provide focus for this national discussion.
In overview, the proposals suggest three actions:
- include new groups of specialists and services under public healthcare
- construct or subsidize new support facilities to make existing general care hospitals more efficient
- Use digital health information to speed up access to care
The authors argue that these investments will, in some cases, result in lower costs but it is clear that the goal here is better service. I will begin with some of the more novel proposals (at least to me) and work towards those that have received alot of attention in the media.
- Naturally Occurring Retirement Communities (NORCs) – Though social services have established networks to support retired Canadians in their own homes, this could be intensified where communities reach a threshold of older residents. These NORCs could be funded to provide regular contact, food delivery, and basic health care so that longterm care can be successfully postponed or avoided.
- Digital referrals to and consultations with specialists – Canada has been slow to use digital health information to get quicker turn around on questions from family doctors (e-consultations) and shorter wait times for specialist appointments (e-referrals). Standard formats for health data and provincial mandates to use centralized systems could shave days off consultations and weeks off of referrals.
- Specialized day surgery centres – Studies in the United States have shown that specialized surgery centres without overnight care requirements can accomplish the work 25% faster at half the cost. The authors do not recommend the private sector approach pursued in some provinces but a publicly funded approach that would not cherry pick the easiest cases or the best doctors.
- Improve job standards and regulate Personal Support Workers – Though they play a non-medical role, these workers are essential to elderly Canadians extending their independence in their own home or receiving long term care. Better salaries and clearer expectations will improve retention and prevent a recurrence of the deaths that plagued Canada’s longterm care homes during Covid.
- Promote the role of nurse practitioners in routine healthcare – Nurse practitioners can perform many of the roles now filled by family doctors and help address the current shortage of family doctors in a cost effective way.
- Get quicker diagnoses through expert-designed information systems – Whether it is cancer, Alzheimer’s or some other disease that is not easily recognized, a variety of tests and specialist opinions have to come together to create a definitive course of treatment. With the right design, digital health information can make that happen sooner.
- Address hallway medicine by building transitional care units – One of the keys to effective hospitals is that admissions should equal discharges. Emergency rooms tend to get backed up because they have no place in the hospital for the after-care that many admissions require. By creating transitional care units with relatively low overhead, the hope is that beds will be less likely to line the corridors.
- Talk therapy for everyone who needs it – Covid has underlined the importance of mental health. However, without financial access to the 6 to 12 hours of talk therapy that helps 50% of those with anxiety or depression, many patients deteriorate. Subject of an earlier national initiative in Canada, much more could be done in this area to improve the outlook and economic productivity of ourselves and our neighbours.
- Pharmacare – The Globe & Mail series offers practical steps to make this long sought-after extension of healthcare a reality. The current federal government has committed to make progress towards universal coverage of this critical aspect of modern medicine as part of its deal with the New Democratic Party to keep it in power until 2025. The provincial premiers, however, are unimpressed, even if this move will bring some efficiencies in the overall cost of drugs in Canada.
- Longterm care – Rebuilding and improving the infrastructure for elderly Canadians who can no longer care for themselves is a common goal for those concerned about healthcare. Funds for these investments could come from insurance programs, such as those found in Germany and Japan.
Some combination of these ideas will help those who are suffering in Canada’s hospitals. These ideas also call us to re-examine what is the role of individuals, regions and nations in taking care of their sick. Are we doing enough? If not, how do we contribute as a community?