I remember watching the TV in the hospital visiting room on my last shift as a volunteer before the pandemic. The news was all about Covid. It was clear that the risks had become too great for non-professionals like me. The nurses, doctors and patients would have little choice in the months and years ahead. I would stay at home but they would face the storm. It is no surpise that, three years and 51,800 deaths later, Canadian hospitals are spent and facing a recruiting crisis.
The provinces that fund healthcare have been demanding more federal funding to meet the challenge. In February of this year, the federal government announced a program amounting to two-thirds of the $300 billion requested by the provinces. Identically-worded announcements of an agreement-in-principle were then issued for each province but Quebec. This latter is still awaiting further discussion – though it is understood that each agreement will have specifically tailored action plans to address provincial concerns. According to the federal government, all of these plans will address :
- Access to family doctors and nurses, including in remote areas
- Resilience and support for the health care workforce
- Access to mental health and addiction services, and
- Electronic recordkeeping
The key issue facing health care systems across the developed world is the increasing portion of the economy consumed by health care services, rising to almost 14% of GDP in Canada during the pandemic. This places Canada second only to the United States in pouring our wealth into health services. It is not clear why this increase is occurring. Aging populations are expected to increase medical costs for several decades to come but cannot be blamed for more than a small proportion of the annual rate of increase. One study in Ontario showed a 35% increase in the cost of end-of-life care (in constant dollars) between 2005 and 2015. This suggests an intensification of medical efforts in the last years of life, whether through the use of more sophisticated approaches or the increasing inefficiency of medical service as compared to the rest of the economy.
In addition to these rising costs, there is pressure to increase the proportion of costs paid for by the public. Canada has a relatively low percentage of publicly funded health care (75%) when compared to most OECD countries but, of course, it is usually compared to the much more privatized (55% publicly funded) American system. The Liberal government and its New Democratic Party supporters are working on dental and pharmaceutical coverage as well as the expansion of mental health services mentioned above.
It will be interesting to see which of the techniques discussed in last year’s series by the Globe and Mail on health care reform will see increased investment as a result of the new federal-provincial action plans. It is clear that simply spending more money will not heal the beleaugered Canadian health system. Health care is key to our sense of security. Investing wisely over the next ten years and reflecting deeply on what our doctors, health professionals and hospitals can actually offer will help us regain that sense of security.