Healthcare Can’t Improve Until Its Structure Is Changed

Patients need the power to make choices. When they can do that, wait times will shrink, outcomes will improve and spending will be constrained. Tilting at the straw men of privatization and parallel systems does nothing to advance the debate. We deserve better.
Published on April 8, 2008

Very few Canadians would deny that Canadian healthcare is flawed. Costs are high, access is uneven, and wait times are among the worst in the world. When our system is compared to that in the U.S., the discussion often gets fixated on privatization as a cure-all, and the benefits and problems of introducing market forces into healthcare. Instead, it can be instructive to look to other jurisdictions, like those in Europe.

The reality is that our existing bureaucracies are behind many of the inefficiencies, lengthy wait times and high cost of healthcare in Canada. Many potential improvements have nothing to do with the source of funding, public or private. The Frontier Centre’s recent Euro-Canada Health Consumer Index is a useful tool in identifying and addressing these problems. It shows that Canada performs very poorly compared with European countries, with respect to waiting times for diagnosis, treatment and surgery.

The index also found that our spending per-capita on health care is extremely high by comparison, exceeded in Europe only by such wealthy states as Switzerland and Luxembourg.

Both these conditions arise from the inability of Canadians to make necessary choices about what doctors they see, what treatments they want, and how they want them delivered. We are shackled by a system of healthcare modeled after William Beveridge’s, who designed Britain’s National Health Service more than 60 years ago.

To determine why we are doing so poorly compared to Europe and at such a high cost, we can look at Britain’s National Health Service — the sick man of Europe’s systems. Britons, though, have an option that Canadians do not: they can opt out of the NHS and seek private treatment, as increasing numbers do.

Canada’s problems, like those of the NHS, stem from the fact that healthcare service is funded and delivered by the same agency. These self-payments create a conflict of interest that undermined Britain’s recent attempt to fix emergency room wait times. The British Labour government set a target that required all patients to be treated within four hours of their arrival at an ER. Under pressure to meet this goal, administrators refused to let patients enter the ER, where the clock would start ticking, until backlogs were cleared. Last year, more than 40,000 patients sat in ambulances parked outside hospitals for an hour or more before they were allowed enter the ER and start the clock on their four-hour wait time.

The system could claim it met its targets, ignoring the obvious inhumanity of storing sick people in parked ambulances and the stupidity of using a mobile vehicle as a hallway-on-wheels. Inevitably, in closed systems like those of Britain and Canada, the focus switches from the needs of the patients to the needs of the system itself. Patients must sit and wait while their only insurer-provider plays bureaucratic games.

To be sure, not all healthcare in each European jurisdiction is perfect, even in the high-performing systems. We should learn from the mistakes in European policy, as well as from their successful innovations. It would be foolish to ignore the wealth of data Europe provides on the strengths and weaknesses of the different approaches to the provision and funding of healthcare. There is also room to apply best practices from within Canada, such as centralized waiting lists and multidisciplinary treatment teams, to achieve improvements within our existing structure.

Serious and lasting change will require redesigning our system, but we do not need to wait for the emergence of deeper reform to begin making improvements. Fortunately, we need not reinvent the wheel, when there are so many examples of best practices in the European states. Canadians need only identify what reforms best suit our needs and to figure out how to remove the bureaucrats – the people who manipulate statistics, often at the expense of patient care, as they put numbers in documents ahead of the well-being of the sick.

Patients need the power to make choices. When they can do that, wait times will shrink, outcomes will improve and spending will be constrained. Tilting at the straw men of privatization and parallel systems does nothing to advance the debate. We deserve better.

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