Canada’s ‘Not’ World-Class Healthcare System
What Can Canada Learn from the UK to Fix Canada’s ‘Not’ World Class Healthcare System
After spending 26 years in Canada I moved to the UK in 2004, where I have lived ever since. Being an ex-ballet dancer who had to stop due to injury means that I have been an extensive user of the healthcare systems in both countries. Through this experience I have gained some insights into both systems that I think could help Canada’s system improve.
Canada’s ‘universal’ healthcare system became a national program with the passing of the Hospital Insurance & Diagnostic Services Act by the Canadian government in 1957. With this Act, the federal government agreed to fund 50% of the costs covered by provincially run universal healthcare plans, covering services delivered by doctors and hospitals. With the passing of the Canada Health Act in 1984, extra-billing and user fees were banned by the federal government, meaning any provincial Medicare plan with ‘user-fees’ ran the risk of losing funding from the federal government.
While the universal nature and ‘free at point of access’ nature of Canada’s system has its advantages, I believe Canadians need to look outside Canada and away from our neighbour to the south at other models.
Why does Canada’s system need to change? Well, because based on a selection of measures, Canada’s system fails on several counts. In an assessment by the Commonwealth Fund in 2014 of the healthcare systems of 11 large developed countries, Canada ranked 10 out of 11, just ahead of the USA. In the areas reviewed by the study Canada scored poorly in each:
An interesting feature of healthcare policy debate in Canada is that the media, politicians, and healthcare unions generally focus on comparing the Canadian system against the US, with the conclusion being, Canada’s is better. What gets missed in the debate and analysis is that by looking at only the US, the debate is limited to comparing Canada’s system to a US system that is deemed the worst system when compared against 11 major developed economies.
Canadians need to stop being smug about our system being better than that of the US and look to Europe to see how poorly our system performs and to find ways to make Canada’s system better.
My experience with both the Canadian and UK systems has shown me some areas where Canada’s system could be improved by adopting some features of the UK system.
GP / Family Doctor Access
When I moved to London I expected to struggle to find a GP, given that I lived in a busy central London district. I was surprised to find that GP clinics generally have to accept patients who live in the local ‘catchment area’, as outlined on a map. Thinking back to my time in Alberta, when our family Doctor passed away, my mother and siblings struggled to find a GP who would take them on. Some of them waited several years to find a permanent GP, instated, heaving to rely on ‘walk-in’ clinics, with long waits and a lack of continuity of care.
Imagine if my family had been able to quickly register with a local GP, or even better, another doctor or group of doctors, were required by the government to take them on following the closing of my family Doctor. Being able to easily register with a local GP practice based on home address (or even better based on where you live or work) is a feature of the UK system that Canada should seriously consider.
I came to London to study at university. Before I moved away from Canada I made sure to get a large refill of my regular prescription drugs from my doctor so that I could ‘run them through’ my employer provided drug coverage. Little did I know that prescriptions in the UK cost only £8.40 per prescription (with schemes to provide free or reduced price prescriptions for low income, seniors, chronic conditions etc.).
The UK’s National Health Service is able to make ‘bulk’ purchases of drugs for the UK’s 64 million residents, resulting in significant cost savings. Canada should seriously consider creating a national drug plan, eliminating the need for private drug plans and a mish-mash of provincial plans. Not only could this save money, it could make drugs currently too expensive to cover on private plans available to Canadians through bulk buying.
When I started university in London back in 2004, I didn’t think that I would need to visit a hospital during my one-year Masters degree. However, I found myself needing to see a specialist as well as have minor overnight surgery.
When my GP said I needed to see a specialist for a non-pressing condition my first though was, ‘God, how long will that wait list be?’ My experience in Canada being one where people waited months and even years to see a specialist. To my amazement, my GP said I could see a specialist that same day by taking my referral to the ‘walk-in’ specialist clinic at University College London Hospital, staffed by a team of specialists.
While not all areas will have the population and demand to support ‘walk-in’ specialist clinics, the speed of access and subsequent surgery that I experienced amazed me. I would have waited well over a year back in Calgary to go from GP to specialist to operating room. I think Canada should identify specialties with high demand / high volume and develop walk-in clinics to provide patients with quicker access to care.
An interesting feature of the UK’s public health system is the provision of many publicly insured services by private companies. This means that a patient on the NHS may have surgery or treatment provided by a private company, paid by the NHS. The aim being to provide NHS patients with timely, quality, and cost effective care. While in the UK some view this provision as controversial, I can see the merit of it, if properly managed.
Looking back at the career of my mother, a Registered Psychiatric Nurse (RPN) in Canada, I can think of a few ways where the Canadian system could benefit from the private delivery of publicly funded services. For instance, at one point my mom worked in a department in a hospital that provided short-term outpatient mental health therapy, primarily one-to-one talk therapy sessions. Her program was housed in a hospital and staffed by RPNs, psychologist, psychiatrists, and social workers. They worked 8-hour shifts between 9am-5pm and oddly were only mandated to see 4 patients a day (for hour long sessions).
Imagine if she and her colleagues had been able to set-up a company that rented out cheap space in an office park or shopping complex (close to where patients work / live), was open from 7am-8pm (hours convenient to working patients), and where staff saw 6 patients in an 8 hour shift. This company could contract with the local health authority to provide free publicly funded mental health care. This model would free up expensive and in demand hospital space, while offering patients more choice of appointment times closer to their community. I suspect that this model would be cheaper for the government to fund, while providing a decent profit to my mom and her colleagues.
In Canada we all believe that people have a right to good quality food and clothing, but would generally not trust the government to have a monopoly on the making and selling of food and clothes, so why do we think the government is the best entity to fund and deliver most healthcare services? It is time that Canada had a sensible conversation on how private for-profit and non-for-profit companies can help deliver innovative healthcare solutions that can be cheaper and better than those delivered by the government.
As a Canadian, I had never had full private medical insurance or access to hospitals and doctors where I could pay to quickly get care. Before moving to London, my only experience with private medical insurance was my employer provided plan that covered me for dental care, physical therapy, and prescription drugs, all generally excluded from the publicly funded healthcare system.
I have always struggled with the concept that in Canada I could pay to get my cat quick cancer treatment but my dad could not do the same, unless he went to the US. Nor could I buy private medical insurance to get quick access to diagnostic tests and treatment, though I could for my pet. While I believe that the public system should provide timely and quality care to everyone, I also believe that people should be free to access care in Canada on a private basis.
The private system is not perfect in the UK (e.g. many treatments are delivered in a way to that cost much more than necessary), though it does provide people who can afford it with a way to access quick care, while taking people like me out of the queue for the public system. I guess truly wealthy Canadian’s have always had access to private care, by travelling to the US. I believe that all Canadian’s should have access to private care in a more affordable way, through a system of private medical insurance and care.
While there are strengths and weaknesses to Canada’s and the UK’s health systems, my experience of the two has identified some clear areas where Canada can learn from the UK. For Canada to take advantage and benefit from some of the ideas I put forward here, the Canada Health Act needs to be amended. I hope that Canadians will start to have a more global debate about our healthcare system, look away from the US as the only alternative system, so that we can have a system that encourages innovation in the delivery and financing of timely, quality, and affordable care, which is not the system that Canadians have at the moment.