Shaun Francis is CEO and President of Medcan Health Management, one of Canada’s largest providers of health and wellness services. He recently participated in the CD Howe Institute debate Let it be resolved: competition will save Canada’s broken health care system.
25 years ago, I secured the rights to a state-of-the-art telehealth system and brought it to Canada. Patients called a number to receive instant advice on their medical issue and be efficiently directed to an appropriate level of care. I thought it would greatly benefit Canadians and save insurers millions.
In a single-payer system, such as in the provinces and territories of Canada, my solution would have reduced the burden on emergency rooms and helped minimize staffing demands for hospitals.
But the Ontario government didn’t buy it. She ended up buying a low-cost nursing phone line designed to generate revenue for hospitals, encouraging callers to go to a hospital’s emergency room.
For what? Because the upfront cost was cheaper – and the decision maker was not responsible for hospital operating costs. This type of short-sighted decision-making is characteristic of what happens day in and day out in government monopolies.
This is why we need a competitive private alternative to our universal public program, with a mix of private and public providers and competitive private insurers. The competition and innate market incentives that exist when clients can choose from a range of options serve to improve care. This is what will solve our health care crisis.
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Consider the debacle surrounding Phoenix, the federal government’s disastrous payroll software. Launched in 2016, its development and problems cost billions of dollars, yet its mistakes have affected 500,000 federal public service workers in recent years. It is so bad and so full of errors that the federal government is replacing it with a new system – at another huge cost. What about the now infamous ArriveCan app? Experts said the $54 million cost could have been less than $1 million, more than 50 times more than needed. Not to mention the endemic cost overruns and delays in the purchase of the F-35 fighter jets that the Canadian army so badly needs.
What do all these stories have in common? All were the product of government monopolies.
In some ways, as Canadians, we have been taught to expect such mismanagement. Yet many of us cling to the illusion that Canada’s monopoly of health care insurance and delivery is somehow different. Our unshakeable belief in a health care monopoly has resulted in a broken and outdated system.
Consider that the median waiting time between your referral to a general practitioner (family doctor) and a consultation with a specialist is more than 12 weeks. This wait time is about three times longer than in 1993, when it was about four weeks. And if you’re in Ontario, do you know how your primary care physician makes this referral? By fax. Technology so outdated and flawed that it is the leading cause of unauthorized disclosure of personal health information. Nearly 5,000 privacy breaches related to misdirected faxes were reported to the Office of the Privacy Commissioner in 2021 alone. It is amazing that faxes are still used today.
Also consider that the cost of public health insurance for the average Canadian family (two parents and two children), adjusted for inflation, has risen more than 80% since 1997 and nearly 108% for a single Canadian. . We spend about 12% of our GDP on health care, more than 27 other comparable countries in the Organization for Economic Co-operation and Development. But among these countries, Canada ranks 32nd out of 38 in the number of hospital beds, 27th out of 31 in the number of doctors and 17th out of 30 in the number of nurses.
Emergency rooms across the country are closing simply because hospitals don’t have enough staff. Foreign health professionals cannot be licensed. And too few places in medical schools exist for Canadians. Canadians are literally dying before they get the care they need.
Some might say that it is enough to fund this system well, hence the new health accord between the federal government and the provinces. But let’s recognize this for what it is: a stopgap solution. How many times have we seen the federal government offer a new deal to the provinces?
Health care is already the single largest budget item for all provincial governments in Canada, as our population across the country ages. Health expenditure per capita is significantly higher for people aged 65 and over than for younger people. Spending per capita for the 80-85 age group was already more than double the spending of all age groups in Canada in 2017. Assuming no change in input prices For the delivery of health care services, the growth in the number of Canadians aged 65 and over will lead to an increase in health care spending of approximately 88% from 2019 to 2040.
While we are short on money, ideological dogma has given us one of the worst performing health sectors in the developed world. Often we see the United States as our only alternative. No one is suggesting that we adopt what the Americans have. But in Canada, we don’t have a health care system; we have a queuing system. And if Canadians want world-class care, we need to think world-class.
Every system in the world that ranks and performs better – Switzerland, the Netherlands, Germany, Japan and Singapore, to name a few – has a competitive private alternative to its universal public curriculum. These systems place patients at the center of their processes.
Only a model with more public-private competition can give us a more efficient healthcare system, with more innovation, shorter wait times and better care than we have today.