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One-quarter of Canada’s population will be over 65 by the year 2030. (Design Pics/Thinkstock)
One-quarter of Canada’s population will be over 65 by the year 2030. (Design Pics/Thinkstock)

Globe editorial

When a stagnant health system meets an aging population, disaster awaits Add to ...

Since we are all going to get old and die one day, we have a stake in how well Canada’s health-care system looks after senior citizens. The problem is, not many of us are confident that it’s going well. The Canadian Medical Association (CMA) released a poll in August in which Canadians expressed a sincere set of worries about their medical prospects in old age. Four out of five said they aren’t confident they’ll be able to access the health services they will need. Three-quarters are worried they won’t have the money to pay for services that aren’t covered by medicare after they retire. And 61 per cent doubt the country’s hospitals and long-term care facilities will be able to meet the demands of Canada’s relentlessly aging population.

But it’s not just citizens that are worried. The CMA’s 83,000 members are fretting, too. They are living with the consequences of a fractured and poorly integrated health-care system that operates too often in crisis mode. Canada’s “silver tsunami” – the massive wave of people who will turn 65 in the next 15 years – hasn’t made landfall yet but is already causing grief. Hospitals in Ontario exist in “code gridlock” for weeks on end, according to CMA president Chris Simpson. The new normal for doctors, nurses and hospital administrators is the daily struggle to find places for elderly patients who should be in a long-term facility instead of on a gurney in a hallway.

Which is why it is easy to endorse the CMA’s call for a national seniors strategy. Dr. Simpson and the CMA have been making the rounds since last fall, telling anyone who will listen that Canada can’t afford to simply hope for the best any more. By 2030, one-quarter of all of us will be over 65 – close to eight million people. And yet, at a time when our health-care system needs to be girding itself for a new reality, it is in fact falling behind other developed countries in terms of quality, effectiveness and efficiency. As Dr. Simpson said in a speech in November, if Canada’s medical workers are able to do a good job, it is “despite the system rather than because of it.”

Most Canadians would probably be a little shocked to hear that their country is no longer the international darling of universal health care. But it’s true. Out of 11 countries, ours is ranked 10th by the Commonwealth Fund, a private American foundation that compares the United States’s health system with those of other nations. The U.S. habitually takes the 11th spot, but we’re right there behind them.

Compared with Australia, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the U.K. and the U.S., Canada has the worst “timeliness of care” and the second-worst overall efficiency. According to the 2014 report, “sicker adults in Canada were the most likely to experience delays in being notified about abnormal results.” Only 30 per cent of doctors in Canada get computerized alerts or prompts about a potential problem with a drug dose or interaction, compared with 88 per cent in Australia, 93 per cent in the Netherlands, 89 per cent in New Zealand and 85 per cent in the U.K.

We have the longest wait times in emergency rooms. One in two Canadians in 2014 couldn’t see a doctor the same day they felt they needed medical treatment; two-thirds say they don’t even bother trying on weekends or in the evening. Based on our rankings, we are also among the least advanced of the 11 nations when it comes to the electronic transfer of records between family doctors, specialists and medical clinics.

We could go on. And it could get uglier. Dr. Simpson points out that, thanks to the Affordable Health Care Act, a.k.a. Obamacare, the U.S. might conceivably bump Canada down into last spot within a year or two. The U.S. health-care system is getting better, and ours is stagnant, at best.

Our lack of co-ordinated preparation for the silver tsunami is a symptom of this stagnation. Ottawa, the provinces and the territories remain siloed within their jurisdictions. They lack the political will to join forces and face reality. And yet, that reality is being shoved in the health-care system’s face every day. According to the CMA, 15 per cent of acute-care beds in Canada are filled with aging patients who should be released into the care of family or placed in a long-term-care facility. Instead, they are being warehoused, exposed to hospital superbugs and are at risk of falling down for lack of adequate supervision. About a third of them have dementia.

The related costs are staggering. Keeping a chronically ill patient in a hospital bed costs $1,000 a day, compared to $130 in a home, or $55 with home care. If nothing changes, seniors will account for almost 60 per cent of health-care costs in Canada in 2030, the CMA warns.

What needs to be done is not complicated. Instead of spending billions on makeshift solutions and bad outcomes, Canada’s health-care stakeholders should be spending that money on new, properly staffed long-term facilities. But who will build them? The provinces? They can’t afford it. Ottawa? Not its jurisdiction. It’s code gridlock all over again.

The CMA is looking for a partner in its call for a national strategy for seniors. As a national body, its obvious choice is the federal government. The Green Party, the NDP and the Liberals have committed themselves, to varying degrees, to making the establishment of a national strategy part of their election platforms. The ruling Conservatives have yet to do so, according to Dr. Simpson.

All the parties should get on board with this, without qualification. When the election campaign starts in earnest, the politicians will gab on about lower taxes and safer streets. The CMA has done us all a favour by identifying an issue that is far more pressing but woefully underappreciated in Ottawa. The tsunami is coming. We can be ready, or we can get washed away.

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