As people and governments struggle to find a strategy to fix a broken healthcare system, we might consider some of the articles published in August 2022 that have addressed this issue.
Some topics from August
Eesha Affan of CBC News reports about an activist who says private clinics will pull health professionals away from publicly funded care and a co-founder of a private health care service who believes Canada’s strained system can’t meet the needs of citizens.
Alexandra Rose, the The Nova Scotia Health Coalition's provincial coordinator, says while private care might provide a temporary solution, it makes the shortfalls in Canada's public health care system even worse.
Doctor Parking Spaces
"Every time a private clinic opens, doctors leave the public sector, doctors, nurses, nurse practitioners. That's less staff working in the public sector, which is only going to exacerbate the extreme staffing crisis that we're already facing," Rose said.
Dr. Adam Hofmann, co-founder of Algomed, says he's a strong advocate for public health care but Canada's strained system can't meet the needs of citizens.
"What public health care does badly is adapt to the times. It doesn't innovate. It cannot innovate. It is too big a battleship to turn around," said Hofmann.
Rose says the responsibility to solve systemic issues lands on the shoulders of the government. She says she's worried private care will dissuade the government from finding long-term solutions on their own. (Affan & Donaldson, 2022)
Ali Amad, writing for Macleans magazine, in a discussion with Dr. Andrew Boozary dissects proposed solutions like privatization and prescribes a new approach to delivering health care across Canada.
Traditionally, our health care system is structured around hospitals and doctors working on their own in an urban neighbourhood or rural community. To modernize health care delivery, we must shift from this archaic and rigid structure to a more dynamic team-based approach. Instead of forcing patients to deal with our siloed health care system, which splits services into different locations or departments, each with their own procedures and red tape, teams of primary care physicians, nurses, specialists and social workers could work together in one setting or travel together as mobile units to underserved communities. Health care can then be collaboratively delivered in a much more time- and cost-efficient approach that benefits providers and patients.
An integral part of this team-based approach is an investment in more community health workers. Typically trained and employed by community health centres, community health workers tend to be locals with shared lived experiences who can act as guides and advocates for their community members. For my immigrant single-mom patient, a community health worker who speaks the same language would be an ally who can help enrol her with a family doctor and ease some of her daily life burdens. (Amad, 2022)
Danielle Edwards of CBC News notes that Premier Houston says his goal is to get Nova Scotians good health care quicker.
Nova Scotia NDP Leader Claudia Chender said on Wednesday the possibility of a private system overtaking the public one is always present.
"To indicate that there is no slide toward private health care is to willingly ignore the evidence," Chender said.
"When we say that we're concerned about a slip into private health care, what we're talking about is all of the existing ways in which people are right now paying to access health care," she added, pointing to the private, subscription-based clinic that recently opened in Dartmouth as an example.
"That includes the private clinic that's opened in Dartmouth, telemedicine and other ways in which Nova Scotians now, if they have the means, can pay for health care that others can't," she said. "That remains a concern for us."
Liberal Leader Zach Churchill said he was not assured by Houston's comments.
"One of the biggest issues we're having in health care right now is a labour shortage, so if you create a private health care delivery system, undoubtedly I believe that is going to siphon more staff out of our public health care system and make the labour shortage worse in health care," Churchill said. "I think you're creating a very big risk." (Edwards, 2022)
Healthcare political opinions
Yasmine Ghania reporting for CBC News interviewed Steven Lewis, a health policy consultant formerly based in Saskatchewan and adjunct professor of health policy at Simon Fraser University in British Columbia, who says the government should be building up the public system instead of turning to the private sector.
"If there is some advantage in having a stand-alone surgical clinic that does nothing but these kinds of day procedures, it would be just as efficient to build them and operate them in the public system," Lewis said in an interview with CBC News. (Ghania, 2022)
Jacques Poitras of CBC News writes that things are going to change in New Brunswick according to Premier Higgs.
The two opposition parties quickly denounced his comments.
"This is deeply concerning," said Liberal Leader Susan Holt.
"Our health-care system is falling apart, with ERs closing, waiting lists exploding, and health-care professionals pushed past their limits, and this government, sitting on a surplus, wants to make room for profits from the system?"
Holt vowed to "do everything I can to prevent this."
Green Party MLA Kevin Arseneau called any privatization "a race to the bottom" that would weaken the system further and make it inaccessible to working class people.
The province ran surpluses of $408 million in 2020-21 and $487.8 million in 2021-22. A surplus of $35.2 million is projected this year. (Higgs Sees More Private-Sector Delivery of Health Care as an Option, 2022)
An article in the Economist explores how friendships across classes are important aids to social mobility for young Americans.
One measure seemed especially important. What the researchers called “economic connectedness”—the extent of friendships across social classes—was strongly associated with increased rates of high-school completion, reduced rates of teenage pregnancy and increased income for those born poorer. Moving from a place where friendships across social strata are relatively uncommon (a one-in-four chance of a friendship between someone in the bottom half of the class distribution and someone in the top) to one where it was relatively standard (a one-in-two chance) translated into an 8.2 percentile increase in future earnings, the researchers found. (A New Study Shows How Much Social Capital Matters, 2022)
The delays that patients endure in seeking health care has renewed interest in the question of the value of outsourcing procedures like surgeries to independent service providers. For the National Health Service in the UK outsourcing of NHS services to the independent sector is not a new phenomenon. The BMA is concerned that the Government's pandemic response and newly published elective recovery plan heavily reflect its commitment to further embedding the independent sector into the fabric of health services delivery. In February 2022, The BMA surveyed members to better understand their views on the outsourcing arrangements in place with ISP hospitals, and the potential trade-offs or implications this may have on doctors, patients, and the NHS more broadly. Many of the concerns of the BMA members are relevant in our circumstances as conservative governments consider offering more health services to private service providers.
Our research found that doctors are largely divided as to whether purchasing additional capacity from the independent sector would improve the ability to manage pressures on NHS hospitals. Two in five doctors (39%) feel that ISP contracting will significantly worsen the ability to manage NHS pressures, compared to just 29% who believe it would improve. (NHS Outsourcing, 2022)
Andre Picard, writing in the Globe and Mail, about the Canadian healthcare system comments that we have the worst of both worlds: a largely unaccountable public system, and an almost-not-regulated private system.
Public and private service improvement
In Canada, on the other hand, we have the worst of both worlds: a largely unaccountable public system, and an almost-not-regulated private system.
Worse yet, we pretend that simplistic approaches such as “more private delivery” or “more public funding” will magically solve everything when the real problem in Canada is that the health system isn’t a system, but rather a series of unconnected services that often work at cross purposes, and with an almost total lack of oversight and planning.
The current crisis – grave staffing shortages – is a case in point. We’ve known for years, if not decades, that this problem was coming, given the demographics of the aging work force.
Yet, there is no health human-resource plan. Provinces simply pilfer workers from each other, and then, when they’ve exhausted that approach, look to countries like the Philippines for workers.
That constant lurching from crisis to crisis with no plan, and no vision, is the real problem we need to address in Canadian health care.
The so-called private-public “debate” is the least of our worries. Rather, it’s a tiresome and costly distraction from the real problems that need to be addressed. (Picard, 2022)
The improvement in access to health care and the reduction of wait time for treatment and procedures will require increased funding that will raise the per capita cost of care for Canadians. Dr. Katharine Smart, past president of the Canadian Medical Association, says, on the surface, it might seem privatization would increase capacity and take weight off the public system, but “that's not really what happens.”
“What starts to happen, of course, is differential access to care,” Smart said in an interview Thursday. “So people with more resources have more access, shorter wait times, and people who don’t, do not. “
Smart says, if Canadians want equity in accessing the health-care system, it needs more resources and investments to make it “successful.” (Privatizing Health Care Would Cause Inequity: CMA President, 2022)
A report on a survey counting those experiencing homelessness in Eastern Nova Scotia recommends treating housing as a human right. Housing security is one of the social determinants of health.
Source: Adapted by the article author from Gibson et al. 2011, Sandel et al. 2018, Maqbool et al. 2015, and Braveman et al. 2011.
Treating housing as a human right is an additional recommendation from this report, and a rights-based approach to housing, formalized through
provincial legislation, urgently needs to be implemented in Nova Scotia. T (Service-Based Homelessness Count 2021, n.d.)
Discussion on the best approach to restore timely access, affordability, and quality to our health care system requires consideration of the appropriate role of government and the private sector.
Focus suggested by Picard
Ideological pressure to abandon government involvement or to banish private sector suppliers needs to be avoided as we attempt to synthesize the structure and regulations to improve access, equity, value for money, and quality of service.
References
Affan, E., & Donaldson, J. (2022, August 13). Owner of private medical clinic says it will ease burden on N.S. health-care system. CBC. Retrieved August 13, 2022, from https://www.cbc.ca/news/canada/nova-scotia/private-ns-medical-clinic-says-ease-health-care-system-1.6549725
Amad, A. (2022, August 15). How to fix our broken health care system. Macleans.ca. Retrieved August 17, 2022, from https://www.macleans.ca/society/how-to-fix-our-broken-healthcare-system/
Edwards, D. (2022, August 24). N.S. premier says 'fear-mongering' misplaced over privatization of health care. CBC. Retrieved August 25, 2022, from https://www.cbc.ca/news/canada/nova-scotia/tim-houston-private-healthcare-concerns-1.6561206?cmp=rss
Ghania, Y. (2022, July 29). Turning to private sector to reduce surgical wait times in Sask. a bad idea: critics. CBC. Retrieved August 2, 2022, from https://www.cbc.ca/news/canada/saskatchewan/surgical-backlog-private-sector-plan-critics-1.6536788
Higgs sees more private-sector delivery of health care as an option. (2022, August 22). CBC. Retrieved August 23, 2022, from https://www.cbc.ca/news/canada/new-brunswick/premier-blaine-higgs-private-sector-healthcare-1.6558677?cmp=rss
A new study shows how much social capital matters. (2022, August 1). The Economist. Retrieved August 17, 2022, from https://www.economist.com/graphic-detail/2022/08/01/a-new-study-shows-how-much-social-capital-matters
NHS outsourcing. (2022, March 15). British Medical Association. Retrieved August 18, 2022, from https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/commissioning/nhs-outsourcing
Picard, A. (2022, August 22). Opinion: The private-public debate is a distraction from health care's real problems. The Globe and Mail. Retrieved August 25, 2022, from https://www.theglobeandmail.com/opinion/article-the-private-public-debate-is-a-distraction-from-health-cares-real/
Privatizing health care would cause inequity: CMA president. (2022, August 12). CTV News Atlantic. Retrieved August 30, 2022, from https://atlantic.ctvnews.ca/privatizing-health-care-results-in-worse-access-for-less-fortunate-cma-president-1.6025038
Service-Based Homelessness Count 2021. (n.d.). End Homelessness Today. Retrieved August 3, 2022, from https://www.endhomelessnesstoday.ca/images/Report_-_Service-Based_Homelessness_Count_for_Eastern_Nova_Scotia_2021.pdf
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