COVID-19 has highlighted — not caused — current health care problems in Canada

Posted on March 1, 2022 in Health Debates

Source: — Authors:

TheStar.com – Opinion/Contributors
March 1, 2022.   By Brian Day, Contributor

Governments are to blame for decades of inaction and neglect — yet they now have the audacity to blame COVID-19 for pressuring our health system.

“It’s interesting to note that in the ’90s, not a single hospital was built, that 1,600 full-time nursing positions were eliminated, and that no additional medical school space was developed.”  — Terry Lake, B.C. Health Minister, May 2016

Canadians are subjected to daily media stories of COVID-induced health worker burnout and shortages, hospital and ICU bed deficiencies, and cancellations of life saving procedures for non-COVID illnesses and injuries. These problems are not new and existed long before COVID arrived.

Governments are to blame for decades of inaction and neglect. In the 1970s there were no shortages of nurses or doctors. As health costs steadily rose over the next decades, certain ill-informed health economists opined that too many doctors were treating too many patients, who required too many nurses, and too many hospital beds.

The 1991 B.C. Royal Commission on Health accepted their opinions and governments across the country acted to close nursing schools, cut medical school admissions by 11 to 30 per cent, reduce hospital beds, and close hospitals. Immigrant doctors were also targeted in B.C. (and elsewhere) as the commission advised that government should, “State clearly that immigrant physicians do not have a right to practice medicine in B.C.,” and “Require visa trainees to agree not to stay in Canada when they complete their training.”

One of the commissioners (Robert Evans) had previously written: “A central cause of the problem was the oversupply of physicians, which tended to generate greater utilization of services … there are too many doctors … and a supply-induced demand … a bed built was a (hospital) bed filled.”

This approach was as logical as reducing the number of security guards, police officers and prison staff, to solve a crime wave that was increasing our law enforcement and prisons’ budgets. Evans was awarded the Order of Canada.

Other direct quotes from the Commission, which received national approval and recognition, were: “A true health care system would concentrate on reducing our need for doctors and nurses,” and “I honestly don’t believe there is a shortage of nurses.”

The recommendations were acted upon and succeeded in their goals.

According to the Index Mundi, Canada is now 51st in the world in doctors per population. Our world ranking in the ’70s had varied between fourth and eighth.

The Vancouver General Hospital nursing school had been a major source of graduate nurses, but was one of many schools nationwide that were closed in the early 1990s. Our current nursing shortage is not just in absolute numbers (we exceed the OECD average in nurses per population). Burnout is a problem that long preceded COVID. In 2013, the CBC reported that 25 per cent of Canadian nurses wouldn’t recommend their hospital and 40 per cent were plagued by burnout.

In Saskatchewan alone (the so-called birthplace of medicare in Canada), Premier Roy Romanow closed 52 hospitals. Ironically, he was later chosen to chair the infamous 2002 federal government Royal Commission on health. Canadian data show there were seven hospital beds per 1,000 people in 1976. By 2019, that figure had fallen to a record low of 2.5 per 1,000.

The OECD recently placed Canada 31st in hospital beds per population among developed countries, and speaking to our inefficiency, the Commonwealth Fund reports that each hospital discharge in Canada costs over $4,000 more than the average of developed countries with universal coverage.

Despite our limiting the supply of care, total health spending in Canada was estimated by the Canadian Institute for Health Information to be $308 billion in 2021 ($8,019 per Canadian) representing 12.7 per cent of Canada’s GDP. This ranks among the highest in the world.

Governments now have the audacity to blame the COVID crisis for pressuring our health system. They explain it is due to a lack of doctors, nurses, and hospital beds that they created. Governments are not being held accountable and refuse to accept responsibility for their failings. The COVID crisis has simply highlighted the past mistakes, and it will take years to address them. We need governments to think long term, not in the three to four-year electoral and budgetary cycles they currently embrace.

In a 2016 speech to the Canadian Medical Association, Federal Health Minister Jane Philpott admitted: “It’s a myth that Canada has the best health care system in the world … we spend more per capita on health care than many other countries … but get poorer outcomes for our patients.”

In the 2005 Chaoulli decision, the Supreme Court of Canada stated Canadians were suffering and dying on wait lists. A McMaster study that predicted COVID might cause surgical wait-lists to increase up to seven times was updated in May 2021 with a warning: “As it may turn out, our worse case scenario is turning out to be a gross underestimate.”

According to another recent study, over 11,581 patients died while waiting for procedures in 2020-2021. No other country forces patients to die on hospital wait lists. We are the only country on earth in which a non-state controlled safety valve, including private health insurance for medically needed services, is unlawful.

Concerns about inequity are a red herring. In 2021, the Commonwealth Fund ranked Canada last in equity of 10 developed countries with universal care, all of which allow private insurance. Governments are free to subsidize or fund the premiums for those who cannot afford them.

Existing policies and entrenched ideologies have rationed personnel and infrastructure in Canada. By eliminating options against which their performance can be measured, governments — like all monopolies in all fields — have avoided facing responsibility for the current crisis in health care.

COVID has highlighted but not caused the current problems. Let’s hope the next pandemic does not involve a more deadly virus that will expose our deficiencies even more. It’s time the public demand the action and accountability that they deserve.

Dr. Brian Day is medical director of the Cambie Surgery Centre and a former president of the Canadian Medical Association.

https://www.thestar.com/opinion/contributors/2022/03/01/covid-19-has-highlighted-not-caused-current-health-care-problems-in-canada.html

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