Money Alone Won't Do It

You might hope that the federal infusion of money into our health care system would solve its problems. Martin Regg Cohn writes:

Throwing more money at the system is a proven way to prop up politicians and cheer up health-care workers. But it shouldn’t leave patients quite so reassured.

The biggest challenge facing health care is not necessarily better funding, but smarter spending. Lost in this month’s big news about more federal money is the older question of how to stretch those dollars further in the future.

How do we reduce waste and improve waits? How to defend our medicare values but also value for money? How can we streamline archaic hospital procedures and deliver patient-centred care?

Consider that Canada allocated a bigger chunk of its economy to health care — 12.9 per cent of GDP — than other Western industrialized countries in 2020. Our counterparts deliver universal health care with better outcomes and lower spending — notably New Zealand (9.7 per cent), Australia (10.6 per cent) and other comparable countries such as the Netherlands, Sweden, the U.K. and France.

Rather than compare ourselves to our American neighbours, who spend far more (18.8 per cent) to get far less, we should be asking ourselves why we Canadians keep paying lip service to medicare — and insisting we pay even more money — without demanding greater accountability.

The solutions we need will not be easy to come by:

If only we spent more time thinking about spending rather than just funding, we’d have a healthier health-care system. Instead, we go down rabbit holes debating shared-funding formulas, or private versus public delivery vehicles.

The recent controversy over private surgical clinics is a case in point. Critics warn that Ford’s Tories are unravelling medicare by expanding private cataract replacement clinics at the margins (and in the future, hip and knee surgeries) to reduce growing wait-lists.

A rarefied ideological debate has sucked up all the oxygen in the province, leaving precious little clear thinking. Our publicly-accessible medicare system was always based on privately-delivered care — starting with the doctors and surgeons who are independent contractors, responsible for their own overhead at their privately-owned facilities.

Interestingly, the accusations have largely overshadowed some of the straightforward solutions that might have reduced wait-lists sooner — and obviated the need for private clinics to provide relief. For example, Dr. David Urbach, head of surgery at Women’s College Hospital, wrote in a recent Toronto Star op-ed article that wait-lists are out of control because most surgeons maintain sole control of their own workloads.

Which means you could wait many months if your own surgeon is backlogged, while someone with a different doctor could be operated on within weeks. If Ontario introduced a centralized wait-list for surgeries, we could make the most of what we have instead of clamouring for yet more resources.

Put simply, we have to reorganize health care. And we have a lot of work to do.

Image: The Toronto Star