Canada is spending record amounts of money on health care in the post-pandemic landscape, so why are Canadians still facing challenges accessing it?
Canada‘s 2023 federal budget provided an investment to provinces and territories of $198.3 billion, which includes $46.2 billion in new funding to support the country‘s public health-care system. As such, health spending was expected to reach $331 billion in 2022, or $8,563 per Canadian citizen.
Provinces are also collectively still spending higher amounts on health care than they were four years ago. Yet, many Canadians are still having problems getting a prescription renewed, or a referral to see a specialist and are often still waiting several weeks or even months for critically essential surgery. Polls have consistently shown that large numbers of Canadians report that they experience difficulties accessing specialists, primary care, emergency care, surgeries and diagnostic testing.
Canadians were already facing serious challenges getting access to basic and specialized care prior to the pandemic, but the situation has by all accounts since worsened. One in five Canadians or a total of 6.5 million do not have access to either a family doctor or a nurse practitioner. Those statistics are even higher in the Maritimes, B.C, and Quebec, where one third of the population doesn‘t have access to a primary care specialist.
“Care was delayed during the pandemic and we‘re starting to see significantly more demand and more problems within the overall health-care system. However, there‘s no physician who currently would identify money as the only problem within the system,‘‘ says Lawrence Loh, a medical doctor and the executive director and CEO of the College of Family Physicians of Canada. “Money is critical, but where and how money is spent is also extremely important.”
The Commonwealth Fund‘s recent 2022 International Health Policy Survey of Primary Care Physicians found that 75 per cent of physicians said they believe “the quality of care patients receive throughout the health-care system had worsened since March 2020 when the COVID-19 pandemic began.‘‘
Family doctors are often feeling the brunt of a failing health-care system. Half of Canadian family physicians also reported they were experiencing burnout while 52 per cent of primary care doctors said that they would soon stop seeing patients. Many already have.
Canadians value their health-care system. While some would argue that more private delivery is a solution, those beliefs should be examined in light of compromising the principle of universal and equitable health care for all citizens.
Yet, the question remains: Are there ways to reform the system and make it run more efficiently? Loh points to the need for better funding for primary care as an obvious solution. The College of Family Physicians of Canada reports that 70 per cent of health-care services are delivered by family practices. Yet, Canadian family physicians get only 13.6 per cent of Canada‘s overall public health-care funding.
“Traditionally, health-care funding goes to hospitals,” Loh says. “But if people received better care in their communities, they wouldn‘t need to go as often to an emergency room and to a hospital.”
What needs to happen
The answer according to medical advocacy groups such as the Canadian Medical Association (CMA) and the College of Family Physicians of Canada lies in pursuing administrative reforms and providing better support to family practices. These groups suggest creating interprofessional collaborative teams with general practitioners (GPs) and nurse practitioners who are connected to teams of health specialists, such as dietitians, registered nurses, physiotherapists and mental health specialists. In addition, more emphasis needs to be placed on reducing the administrative burden on GPs by reducing the need to do non-critical paperwork.
“We‘re relying on just one person to do everything from carrying out complex health-care operations without the resources to do so,” says Katherine Smart, past president of the CMA. “We need more integrated care where GPs work in teams where they get the support from other health-care specialists. There‘s also a big need for better home care and long-term care, which would also benefit primary care.“
Advocacy groups also point to the need to support national licensure for physicians, allowing physicians to work across provincial and territorial borders. In addition, there is a need to reform the remuneration system for doctors so they are paid more fairly for their work and for treating more complex cases.
Surgeries have been another cause of concern in terms of accessing the health-care system.
There were 937,000 (14 per cent) fewer surgeries performed in Canada during the first 31 months of the pandemic, for example. While there are improvements in terms of tackling the backlog of surgeries for cancer and hip fracture operations in particular, wait times for joint replacement surgeries remain on average higher than prior to the pandemic. In 2022, only half of patients had a knee replacement within a six-month time frame and only 60 per cent of patients had a hip replacement within the target wait time of 182 days.
“Right now, surgeons are working 80 to 100 hours a week and hospitals are working at 100 per cent capacity across the country,” says Sean Cleary, president of the Canadian Association of General Surgeons, which represents 2,500 members across the country.
Cleary added that many provinces reduced the number of hospital beds during the 1980s and 1990s, which was probably the right decision at the time. However, the system‘s capacity hasn‘t kept track with Canada‘s growing and aging population and the fact that many hospital beds are now occupied by patients with complex and chronic conditions.
Cleary believes surgical care can‘t be delivered in a vacuum and that the entire public health-care system needs to be enhanced so that there is better collaboration between surgeons, hospitals and community care.
A final and often overlooked aspect of the Canadian health-care system has been the need for more nurses.
According to a 2021 Statistics Canada report, there are 32,295 regulated nursing positions that were vacant then, with nearly half of these vacancies remaining open for 90 days or more. A followup report in 2022 showed that one in four nurses (24.4 per cent) planned to change or leave in the next three years due to workplace stress.
“A lot of surgeries are not being performed in Canada due to a lack of staff,” Smart says. “The lack of nurses plays a big part in surgical staffing shortages.”
However, the health-care landscape isn‘t all bleak in Canada.
“We are moving forward,” Loh says. ”There is an overall recognition that the system needs fixing.”