Heath care will only succeed through collaboration, not through competition

Posted on April 19, 2023 in Health Delivery System

Source: — Authors:

TheStar.com – Opinion/Contributors
April 19, 2023.   By Danielle Martin, Contributor

In the real world of health service delivery, the last three years have taught us a great deal. The pandemic has been a test of endurance for health care workers for sure, but it has also tested our ability as a collective system to do something we don’t do enough of: work together.

Here is an incomplete list of the results:

The result was a world-class pandemic response, built entirely on collaboration and co-ordination. Resolving to eliminate competition and work together was the key to every success we had.

Competition, on the other hand, is what happened in New York City, where in the first wave safety net hospitals were overwhelmed with COVID patients while for-profit facilities up the street stood empty.

Competition is also what happens in the most dysfunctional parts of our Canadian health systems, where value for money is most elusive and frustration is highest.

Competition, in a true market for any good or service, requires a set of conditions, including a large number of buyers and sellers making homogenous products; perfect knowledge among buyers and sellers; and mobility of the factors of production. None of these exists in health care, in Canada or anywhere else. Patients are not savvy consumers choosing between near-identical products on the basis of price or the bells and whistles. They are sick people in need of compassionate care close to home.

And providers are not in endless supply, able to move freely around the market. They are highly trained, expensive resources, who need to be marshalled to the area of greatest need. The World Health Organization is projecting a shortfall of 10 million health workers by 2030, and in Ontario alone, there will be a shortage of about 33,000 nurses and personal support workers by 2027-28. Where will the supply come from for competition exactly?

We have a long road to recovery ahead. To suggest that other countries have it better is to ignore the reality plaguing us all: nurses are on strike for the first time in the history of the NHS in England, and President Macron has declared that he’ll be completely overhauling the French health care system, for example. Health care workers have been on strike over working conditions and wages in the Netherlands, Spain, Germany and more — there is no system, no matter the mix of payment and delivery, that is not struggling today.

We are in tough times in Canadian health care and there are more tough times ahead. Service backlogs. Human resources shortages. Mental health impacts. The co-ordinated effort required to manage recovery will probably dwarf what we have just achieved. More competition and fragmentation is the last thing we need. Collaboration is our only hope.

Dr. Danielle Martin is a professor and chair of the Department of Family and Community Medicine at the University of Toronto. This essay is drawn from her argument at the C.D. Howe’s latest Regent Debate: Be It Resolved, Competition Will Save Canada’s Broken Healthcare System.


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