Can money buy healthcare solutions?

Spending on healthcare varies across Canada. According to the Canadian Institute on Health Information, “total health spending in Canada is expected to reach $331 billion in 2022, or $8,563 per Canadian.”

In 2022, Statista reported provincial and territorial health expenditures per capita ranging from $15,880 in Nunavut to $5,027 in New Brunswick.

What can explain the huge disparities in the numbers? First, according to Wikipedia, Nunavut covers 1.8 million square kilometers. The corresponding figure for New Brunswick is 73,440 square kilometers. Second, again according to StatsCan, Nunavut, in the north, had a population of 40,526 people in the reference time period. New Brunswick, along the Atlantic coast, had 812,061 residents.

Healthcare is delivered to Nunavut’s 25 communities through 22 community health centres, regional health centres in Rankin Inlet and Cambridge Bay, and the Qikiqtani General Hospital (35 beds) in Iqaluit (Office of the Auditor General of Canada).

In New Brunswick, there are two Regional Health Authorities (RHAs), amalgamations from the previous eight. These RHAs also oversee 23 hospitals, including four with over 400 beds.

These data suggest that the sparser and more wide-spread the population, the more costly it is to provide healthcare services. With one-twentieth the population of Nunavut and one-quarter the land mass, New Brunswick has some 2,000 hospital beds compared to 35 in Nunavut, at roughly one-third the cost per capita.

What can we learn from this? First and foremost, that money cannot explain the state of healthcare delivery across the country.

It is worth bearing this in mind when we look for solutions to the state of healthcare delivery in Canada, especially since the problems are similar across the country. People want their healthcare provided closer to home. They want one-stop-shopping for their healthcare requirements. And they dislike waiting.

Perhaps the money is not really the issue. Perhaps the huge amount of money currently spent on healthcare in Canada is not being spent as effectively as possible. In other words, perhaps we should be looking at how to get the most for the dollars spent rather than more dollars for the same situation.

This is not a new idea. Unfortunately, however, it is a concept that requires more than Band-Aids® to make significant improvements.

Since the onset of the COVID-19 pandemic, headlines have outlined the seriousness of the shortage of family doctors – and some specialty physicians. The same is true for registered nurses and other ancillary healthcare workers. Paramedics are in short supply, which exacerbates the ability to keep open emergency departments, especially in small communities.

Nurses and physicians, many of whom are baby boomers and beyond, are retiring in droves. Others are leaving the healthcare professions because of burn-out. Professional colleges and associations describe this situation as a vicious circle. The more staff retire, the more stress is put on remaining staff, until they, too, leave. The more the senior staff leave, the greater the reliance on professionals new to their fields.

Less experienced staff take longer to diagnose and treat patients.

These staffing issues are exacerbated by the small numbers of admissions to professional schools instated in the 1990s as a means of reducing the healthcare expenditures then threatening to bankrupt provinces. These 30 years later, the demographic repercussions of these actions are daunting.

The larger graduating groups are now retiring, with smaller numbers to replace them. Moreover, the population has grown from some 28 million in 1993 to just over 40 million as of July 2023. And the population has aged. Statistics Canada reports that between “2016 to 2021, the number of persons aged 65 and older rose 18.3% to 7 million…”

This shift in demographics is significant, as the rule-of-thumb is that people consume 80 per cent of their healthcare in the last 20 years of life.

With a larger and older population, even replacing the number of retiring healthcare professionals one-for-one would fall short of what is needed.

What can help? Money is often claimed to be the solution, but as has been said by many, including this author, it is not. What can help is spending on preventive healthcare services, to help keep the population healthy so that we do not rely on curative services to the same extent.

Think of this from a personal perspective. Would you rather contribute to your own health through lifestyle adjustments? Or would you prefer to become unhealthy to the point that you require hospitalization and intensive treatment?

Diverting funds from the treatment sector to the preventive sector is not an easy move. But surely it can be looked at as a long game, freeing up resources by encouraging a healthier population. Other countries have done this.

New Zealand is a notable example, with a bold goal to “ensure all New Zealanders get the services they need and to meet future challenges.” The fact sheets are comprehensive and available in English and 16 indigenous and foreign languages.

Embracing new technology, including AI, can also help make Canada’s healthcare system more streamlined and efficient. The question remains whether governments will fund major changes, as the pay-offs may be years away. Healthcare delivery is not a four-year, election-cycle-based game.

Electronic record-sharing and home-based services can also reduce the reliance on hospitals and emergency departments. Public education can play a large part in increasing people’s personal responsibility for their health. Supports at home and in institutions will always be needed, but they should be understood in the context of the issues they are meant to improve. They are not the only answer.

Does Canada have the political will to undertake a massive change in the delivery of healthcare to all Canadians? The legal obstacles are seemingly insurmountable. But without changing the longer-term strategy for a healthier Canadian population from sea to sea to sea, the problems will only grow and become even more entrenched.

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