What’s the Issue?
Sustainability is a loaded word. It often turns up when people are discussing what might be wrong with the Canadian healthcare system. In general terms, “sustainability” describes the ability to maintain something at a certain level through conservation or defence. In Canada’s healthcare debate, “sustainability” can trigger a heated argument about whether we can afford the level of healthcare people expect at a cost which is acceptable to Canadians and their government(s). But is Canada’s healthcare really at risk of becoming unsustainable?
These discussions are complicated because we usually aren’t told what is causing the concern: which costs are rising (e.g. public or private), what is being compared (e.g. absolute cost increases or cost increases as a percent of gross national product) and how health costs relate to other financial developments (e.g. is the economy growing or shrinking).
There is also confusion about what proportion of government spending is taken up by healthcare. This is affected not only by how much the government spends on healthcare, but also by how much it spends (or doesn’t) in other areas. For instance, if the government decides to cut back spending on education or police services, then healthcare spending—even if it remains unchanged—will account for a larger percentage of the provincial budget.
So instead of worrying about the unsustainability of healthcare, Canadians should be asking how the numbers are moving relative to other factors such as: private health spending, gross domestic product, government spending in other areas, and tax revenues. That’s the way to sustain an informed discussion on sustainability.
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- In October 2013, the Health Council of Canada hosted a National Symposium on Quality Improvement titled Towards a High-Performing Health Care System: The Role of Canada’s Quality Councils. The forum provided an opportunity for senior leaders from across Canada to discuss health system performance measurement and reporting, as well as opportunities for further interprovincial collaboration on quality improvement. The report titled Canada’s Quality Improvement Conundrum is available on the Health Council of Canada’s Website.
- In the report Better health, better care, better value for all: Refocusing health care reform in Canada, the Health Council of Canada builds on the Triple Aim framework and proposes that better health, better care, and better value for all can be achieved through sustained support of five key enablers: (i) leadership, (ii) policies and legislation; (iii) capacity building; (iv) innovation and spread; and (v) measurement and reporting. The report is available in both official languages via the Health Council’s website, www.healthcouncilcanada.ca.
- Which way to quality? Key perspectives on quality improvement in Canadian health care systems, infographic from CIHI. In this report, the Health Council provides a collective view on the quality improvement roles and an at-a-glace snapshot of the variation in those roles among provincial dedicated quality agencies and pan-Canadian Health organizations.
- Aging of the population is often described as tsunami about to swamp our Medicare system. However, various studies for many years have shown that aging of the population per se will add less than 1% a year to healthcare costs. Although the population is aging and the babyboomers are expected to live longer than their predecessors, the increased number of elderly will be small in comparison to Canada’s overall population and consequently their impact on the delivery of healthcare in Canada will also be small. In reality, health cost increases are driven by changes in the quantity and types of healthcare received by Canadians of all ages, not by demographic changes. An aging population does not necessarily threaten the sustainability of Canada’s healthcare system, but it does create a need to ensure we are able to provide seniors with the right care, in the right place, at the right time.
- CIHI (2011) provides a detailed examination of how aging has affected spending growth over the last decade as well a look at the upcoming challenges brought on by Canada’s aging demographics.
- Healthcare spending as a % of Gross Domestic Product (GDP) has increased gradually over the last several decades, showing sharp increases in the recent past and in the early 90’s – reflecting the impact of a recession. Healthcare spending typically goes up as a percentage of overall spending during recessionary times. Public healthcare spending has risen in absolute terms since 1998, although the Canadian growth rate in per capita health expenditures has been lower than the OECD average. Healthcare spending is also taking a greater share of total government spending in recent years. Tax cuts at both the provincial and federal levels have reduced provincial revenues and contributed to pressures on provincial budgets.
- Detailed health expenditures trends from 1975-2011 are available here, while the most important drivers of health care spending is covered in greater depth here.
Why can’t we fix health care? Blame self-interest
Almost continuously since the second half of the 1990s, Canadians have pointed to health care as their largest national concern and the issue that should receive the greatest attention from Canada’s leaders. Polls taken over the last decade or so have found that health care is typically the highest priority among voters.
Why our health system works for Canada
In the past 18 months I have required two major, but unrelated surgeries, experiencing first hand Ontario’s version of Medicare. The two interventions necessitated down-time and an enforced idleness for reflection on life and what it means to be Canadian. I feel blessed.
Giving doctors more money does not improve access to care
The amount paid to doctors in Canada increased by $7.5 billion in the last five years to reach a total of over $30 billion per year. Put another way, the growth rate of physician remuneration expenditures — what our health system pays to doctors for health services — was more than twice the rate at which the Canadian economy grew over the same period (around 6.4% per year).
‘Super users’ of health care system the target of reforms
An intriguing idea was recently put forward by the Government of Saskatchewan, that of addressing medical hot spots. It has been reported that just five people were responsible for visiting Saskatchewan emergency rooms over 500 times in the last year.