Jeremy is a fourth year student at The University of Western Ontario, pursuing a career in Healthcare Management

Jeremy is a fourth year student at The University of Western Ontario, pursuing a career in Healthcare Management

By Jeremy Gorzelak

Whether it was the War of 1812 or the Olympic gold medal hockey game, competition has always been high between Canadians and our southern neighbors. When considering the specific benefits of living in Canada versus living in the United States, a common retort to the ongoing battle of nationalistic pride is, “Yeah, well our healthcare is free!” But, is it actually? Is this so called “free” system all it’s talked up to be? Sure, our healthcare is much more accessible than in the U.S., and sure, no one goes untreated, but comparing our system to that of the United States is like saying you’re a good hockey team because you beat the Maple Leafs. You, indeed, can go to the hospital, swipe your OHIP card, get treated and never receive a bill, but we are paying for our system with something other than money: with our wait times and sacrificed quality of care.

Canadian wait times are amongst the highest in the world, and is the only health system in the world that is not two-tiered. Not only are the wait times so long that it makes you want to drive your Chevy Blazer through the ER’s double doors. Sort of like a 41-year old man did at Kelowna General Hospital, after waiting 90-minutes and still not seeing a doctor (which is minor by today’s standards).[1] But the quality is also suffering immensely! Our general practitioners have the luxury of running a fee-for-service model through OHIP. This means the more patients they see, the more money they make. Quality of care may fall by the wayside as the doctor is rushing you out the door. So much so that Canadian quality of care actually ranks below many nations such as Switzerland, Sweden and Germany.[2] And here we are so proud of our health system because we’re better than last place (USA).

To solve this quality issue, a fee-for-quality payment model is needed, in which doctors are compensated for the health of their patients rather then the number of visits. Theoretically, the fewer patients the doctor sees would indicate better care, as they are remaining healthy. If doctors focused on spending more time with their patients and addressing all concerns, they would be able to help mediate acute problems as well as the long term chronic illnesses, no more of this one problem per visit nonsense. This proposition may seem counterintuitive, as the doctors are technically getting paid to, in the long run, treat patients less. However, it is not less treatment, rather better treatment, resulting in a decreased need of repetitive visits. If the physician’s goal is to not have you return, then it seems logical for them to do further investigative probing to find out if the patient may have other issues/symptoms, rather then rush them out after one diagnosis.

However, the switch in payment model would bring with it even longer wait times at first as the general practitioners would be spending more time with individuals, so how do we defeat the wait time opponent? Please excuse my cursing; we implement an entire systemic change, and introduce a private, profit- focused healthcare system to operate along side our public sector. Canada leads the world in research publication, but is amongst the lowest ranking when it comes to implementation and innovation. Wait times are not an issue in a private-system that is driven by profit, as this would be like turning down customers at your grocery store because you don’t have enough food to sell. Money is motivation and healthcare systems focused on profit will accommodate the need of its consumers. Furthermore, innovation is fueled by competition and a privatized health care system will ignite competition amongst insurance providers, physicians, and hospitals. Such competition has proved successful in Switzerland and Sweden and has actually brought healthcare costs down, as there is an ongoing battle between private entities for customers (patients).

A private system is a frowned upon concept in Canada as it supposedly directly violates the Canada Health Act (CHA) that states the health system should be a not for profit entity.[3] However, our system is already in the process of privatization, as last year Canada spent $200.5 billion dollars on the healthcare system, 70% of that coming from public funding, while the other 30% from private[4]. Technically speaking, these private dental and rehabilitation industries already operate for profit and violate the CHA. For this reason, I am simply suggesting we face the reality of privatization and make the transition to a 50/50 split, in which competition will spark innovation leading to increased quality and decreased wait times.



[2] The Conference Board of Canada, (2009). Exploring Technological Innovation in Health Systems. Ottawa. http://www.conferenceboard.ca/hcp/details/health.aspx

[3] Canada Health Act (2012). Canada: Department of Justice. http://laws-lois.justice.gc.ca/eng/acts/C-6/

[4] The Conference Board of Canada, (2009). Exploring Technological Innovation in Health Systems. Ottawa. http://www.conferenceboard.ca/hcp/details/health.aspx

 

This article is published under the Bright Ideas project, a joint Ivey International Centre for Health Innovation and NationalHealthWatch.ca initiative aimed at promoting ideas of future leaders and generating dialogue.  Over the course of the next three months, Bright Ideas will profile blogs from Ivey health stream students. 

The views expressed in these blogs are the opinions of their authors, and do not necessarily reflect those of the International Centre for Health Innovation or NationalHealthWatch.ca.