On Thursday, an Ontario panel examining the perennial Canadian problem of wait times released its interim report, but it was quickly overshadowed by the leak of draft legislation purportedly showing the province is preparing to throw open the doors to privatization.
There, in a nutshell, is why nothing ever improves in Canadian health care: We’re so preoccupied with slaying mythical privatization beasts that we never get around to solving real problems.
Many of those problems were outlined in a lucid report from The Premier’s Council on Improving Healthcare and Ending Hallway Medicine. For example:
- 1,000 patients a day are waiting for a bed, most on stretchers in hospital hallways;
- Patients who require admission are spending an average of 16 hours in the emergency room before a bed is available;
- The median wait for long-term care placement is 146 days;
- The median wait for home care is six days;
- There are 4,665 patients designated as “alternate level of care,” meaning they are living in hospital because they have nowhere else to go.
There’s nothing new here other than reminders that the health system clearly does not have the appropriate mix of services. Worse yet, there is a lack of co-ordination that makes it near impossible for patients and caregivers to navigate the system and results in painfully long waits.
The council’s recommendations on how to address these chronic woes will come later. Meanwhile, Ontario NDP leader Andrea Horwath made public a copy of a draft of the Ontario Health System Efficiency Act. (The draft bill was leaked to the NDP by a public servant, who was fired Monday.)
The not-yet-proposed legislation would create a super-agency to oversee delivery of health-care service, along with 70 “integrated care-delivery systems” that oversee the broad range of service providers – primary care, hospitals, long-term care, mental health services and so on.
It’s no secret the new Conservative government is planning to scrap Local Health Integration Networks, the 14 regional agencies created by the Liberals. Now we have an idea of what could replace them. Most troubling in the draft bill is the suggestion that some excellent independent agencies like Cancer Care Ontario, Health Quality Ontario and Trillium Gift of Life will be swallowed up by a super-agency.
There is no perfect health-system structure, but the goal should be to find a balance between streamlined central control and decentralization that allows for specialization and meeting regional needs. Where that sweet spot lies is what we should be debating.
But Ms. Horwath chose instead to describe the draft legislation as a “blueprint for privatization.” The dubious claim is based on the belief that, because the super-agency will have the power to contract out services, it will purchase those services from private providers.
Ontario Health Minister Christine Elliott was immediately put on the defensive, and set out to calm fears that the government intends to create a “two-tier health system.”
Almost all health services are contracted out to private providers – doctors (most of whom are corporations), hospitals (which are not-for-profit corporations), pharmacies, pharmaceutical companies, device manufacturers (for-profit corporations), home care and long-term care facilities (a mix of non-profit and for-profit corporations) and so on.
If the new super-agency is going to streamline and improve procurement of services, all the more power to it. Then there’s the guaranteed conversation stopper: two-tier. In Canada, we apparently dread the notion of people getting better or faster care by paying for it – i.e. cutting into the queue. Except it happens routinely.
For all the self-righteousness about our medicare system, we have the least-universal universal health-insurance system in the world. More than 30 per cent of care is paid for privately. Just not hospital or physician care. Why are all services delivered in hospitals or by physicians deemed “medically necessary” but essential services like prescription drugs, vision care, home care, long-term care and much more are not?
Patients want care that is prompt, accessible, safe, appropriate and affordable (individually and collectively). The structure of the medical system and insurance system used to deliver that care matters very little to them. The way to end the horrors of hallway medicine is with better-organized, more efficient care delivery, not by charging Quixote-like into battle against the alleged purveyors of privatization.
Instead of tilting at windmills, we should be focusing our energies on making essential health care accessible to all and the daily delivery of care more dignified.
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