The Private Sector Must Get a Larger Role in Canadian Health Care

Gwyn Morgan
April 4, 2020
Canada has so far ducked the extreme growth in the Covid-19 hospitalization and mortality rates afflicting some other countries. The worst is certainly still to come, however – and when it does, the shortfall in Canada’s health care capacity will be laid bare. The vulnerability was largely avoidable, points out Gwyn Morgan, if Canada like nearly all other countries had only allowed private health care delivery alongside its public system. When the nation comes out the other side of the pandemic, Morgan writes, a health care policy reckoning will be long overdue.

The Private Sector Must Get a Larger Role in Canadian Health Care

Gwyn Morgan
April 4, 2020
Canada has so far ducked the extreme growth in the Covid-19 hospitalization and mortality rates afflicting some other countries. The worst is certainly still to come, however – and when it does, the shortfall in Canada’s health care capacity will be laid bare. The vulnerability was largely avoidable, points out Gwyn Morgan, if Canada like nearly all other countries had only allowed private health care delivery alongside its public system. When the nation comes out the other side of the pandemic, Morgan writes, a health care policy reckoning will be long overdue.
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The Liberal government’s plan to use Canada’s “fiscal firepower” to help Canadian families and businesses weather the Covid-19 pandemic has received widespread support, even from normally critical sources like the Fraser Institute, which termed it “a measured, well-targeted response”. But no amount of cash can change the terrible reality that Canada’s health care system is one of the least prepared to deal with the crisis. 

For decades before Covid-19 struck, Canadians in every province and territory were suffering, and some dying, on ever-lengthening waiting lists. In an already overloaded system with virtually zero spare capacity, treating burgeoning numbers of Covid-19 patients will necessitate further delay for other patients with time-critical afflictions such as cancer. And that’s already happening. Among the many examples, over the past few days two Ontario women had their cancer surgery cancelled so hospitals could free up capacity for Covid-19 patients.

Long waits on a good day: Canada’s health care system has almost zero spare capacity, plus fewer ICU beds per capita than many other countries.

Canada’s hospital capacity has been in steady relative decline. The latest available statistics comparing 24 developed countries show that in 2017, Canada ranked dead last in hospital beds per capita at just 2.5 per thousand population. Germany, Austria, Hungary, the Czech Republic, Lithuania, France, Slovakia, Belgium and Latvia all had more than twice that ratio.

The United States was only marginally better at 2.8 per thousand, but that’s where the similarity ended. The occupancy level of Canada’s hospital beds that year averaged 92 percent. That effectively meant zero unused capacity since logistics and staffing issues make 100 percent utilization impossible. By contrast, hospital bed occupancy in the U.S. averaged only 64 percent. 

And for intensive care unit (ICU) or critical care beds, which are crucial for successful treatment of the more serious Covid-19 cases, the U.S. ranked first of the 24 countries with 35 ICU beds per hundred-thousand population. Canada had only 12 per hundred-thousand, the same proportion as overwhelmed Italy. With the number of diagnosed infections rising significantly each day, Canadian doctors may before long face the daunting prospect of deciding who will be treated and who will not. Those life-and-death decisions must be made not only for patients with Covid-19, but for other seriously ill patients who are displaced.

Morgan - Inset 2 (above)
When a system cracks: Chaotic scenes in Bergamo, one of Italy’s hardest-hit cities.
When a system cracks: Chaotic scenes in Bergamo, one of Italy’s hardest-hit cities.

A Fraser Institute report released last October on health care in 28 countries found that Canada ranks second-highest in per-capita health care spending, but dead last in access to treatment. This is truly shocking. How could this have been allowed to happen? When the crisis ends, that’s a question that Canadians grieving for their lost loved ones will want answered. But that answer is already clear. 

Canada is virtually the only country in the world that outlaws private health care. Prime ministers, premiers and health care administrators have known for years that our government-run monopoly system was suffering from the dual afflictions of unsustainable cost growth and ever-lengthening waiting lists. Meanwhile, anti-private-sector unions and other entrenched interests vigorously perpetuated the myth that Canada has the “world’s best health system” and engendered baseless fear of “for profit” health care.

The much-maligned private U.S. system has gleaming facilities and ample spare capacity in many states, like the Mayo Clinic in Rochester, Minnesota, pictured.
The much-maligned private U.S. system has gleaming facilities and ample spare capacity in many states, like the Mayo Clinic in Rochester, Minnesota, pictured.

Now, hearkening back to past world wars, Canadian industry is being asked to “retool” to produce the ventilators and other equipment needed to treat Covid-19 victims, along with equipment to protect health care workers valiantly risking their own health to save others. I’m sure industry will do everything possible to help, and the response is already underway. But a question that must be asked is why, two weeks after Canada’s first Covid-19 case was identified on January 25, the federal government sent 16 tonnes of that same personal protective equipment to China. And isn’t it ironic that the private sector is being asked to make up for the failure of a government monopoly that is ideologically opposed to its involvement?

Repeating history? A makeshift Second World War field hospital near Utah Beach in Normandy, France.

Dr. Andy Thompson, a respected rheumatologist with Ontario’s Arva Clinic and Associate Professor of Medicine at the University of Western Ontario, publishes a daily blog sourcing data from national health authorities that compares the spread of Covid-19 in Italy, Spain, Germany, France, the UK, U.S. and Canada. The comparisons are alarming for Canadians.

Because countries are at various stages of the pandemic, to provide clarity regarding the infection’s progression in each country, the comparison is standardized from the date that a nationwide total of 150 cases is detected. For Canada, that day was March 12. By March 30, Canada had 7,708 confirmed and probable cases. This made our ratio of cases per million population – around 205 – about the same as in the U.S. and Italy 18 days after their 150-case mark.

Teutonic efficiency: Germany’s well-organized testing process and health system have helped minimize the country’s Covid-19 death rate.

And here’s where our health care system’s lack of treatment capacity comes into stark perspective. At that same 18-day mark, Canada had the second-highest ratio of cases per hospital bed – just behind overwhelmed Spain. As of March 30, Canada’s cases were doubling every four days. If that rate continues, it will take only two more weeks for total cases to reach 92,496.  

Canada’s doctors, nurses and other healthcare workers are world-class and highly dedicated. We know they will risk their own health doing everything humanly possible as they face an egregious lack of facilities and equipment even without the Covid-19 pandemic. They deserve our support, consideration and admiration. But once this crisis is behind us, Canadians must demand that Canada’s hopelessly dysfunctional and dangerous government-monopoly health care system be opened to private-sector competition, like nearly every other country in the world.

Gwyn Morgan is the retired founding CEO of Encana Corporation.

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