Shaun Francis is the chief executive officer and chair of Medcan Health Management, one of Canada’s largest providers of health and wellness services. He recently participated in the C.D. Howe Institute’s debate Be It Resolved: Competition Will Save Canada’s Broken Health Care System.
Twenty-five years ago, I secured the rights to a state-of-the-art telehealth system and brought it to Canada. Patients called a number to receive instant advice about their medical issue and be directed effectively to a proper level of care. I thought it would greatly benefit Canadians and save insurers millions.
In a single-payor system, like in Canada’s provinces and territories, my solution would have reduced the burden on emergency rooms and helped minimize staffing demands for hospitals.
But the Ontario government didn’t buy it. It ended up buying a low-cost nursing telephone line designed to generate revenue for hospitals, encouraging callers to visit a hospital emergency room.
Why? Because the upfront cost was cheaper – and the decision maker didn’t have responsibility for the operating costs of the hospitals. This type of short-sighted decision-making is characteristic of what happens day in and day out at government monopolies.
This is why we need a competitive private alternative to our universal public program, with a mix of private and public providers and competitive private insurers. Competition and the innate market-driven incentives that exist when customers can select from an array of options serve to improve care. This is what will solve our health care crisis.
Consider the debacle around Phoenix, the federal government’s disastrous payroll processing software. Launched in 2016, its development and problems cost several billion dollars, yet its errors have affected 500,000 federal public service workers over the past few years. It’s so bad, and so riddled with errors, that the federal government is now replacing it with a new system – at yet another enormous cost. What about the now infamous ArriveCan app? Experts have said the $54-million cost could have been less than $1-million – over 50 times more than necessary. Not to mention the cost overruns and delays endemic to the purchase of the Canadian military’s badly needed F-35 fighter jets.
What do all of these stories have in common? All were the product of government monopolies.
In some ways, as Canadians, we’ve learned to expect such mismanagement. Yet so many of us hang on to the illusion that the monopoly in the insurance and provision of Canadian health care is somehow different. Our steadfast belief in a health care monopoly has resulted in a broken and outdated system.
Consider that the median wait time between your referral with a general practitioner (family doctor) to consultation with a specialist is more than 12 weeks. This wait time is about three times longer than in 1993, when it was about four weeks. And if you’re in Ontario, do you know how your primary care doctor makes that referral? By fax. A technology so outdated and flawed it’s the leading cause of unauthorized disclosure of personal health information. Nearly 5,000 privacy breaches related to misdirected faxes were reported to the privacy commissioner’s office in 2021 alone. It’s astonishing that faxes are still being used today.
Consider, too, that the cost of public health insurance for the average Canadian family (two parents and two children), adjusted for inflation, has increased more than 80 per cent since 1997 and by almost 108 per cent for a single Canadian. We spend about 12 per cent of our GDP on health care, more than 27 other comparable countries in the Organization for Economic Co-operation and Development. But among those countries, Canada is 32nd out of 38 in amount of hospital beds, 27th out of 31 in number of medical doctors, and 17th out of 30 in nurses.
Emergency rooms across the country are shutting down simply because hospitals don’t have enough staff. Foreign medical professionals can’t get licences. And too few medical school spots exist for Canadians. Canadians are literally dying before they get the care they need.
Some might say we just have to fund this system properly, hence the new health care accord between the federal government and the provinces. But let’s recognize that for what it is: a stopgap solution. How many times have we already seen the federal government provide a new deal to the provinces?
Health care is already the single-largest budget item for every provincial government in Canada, while across the country our population is aging. Per capita spending on health care is significantly higher for those 65 and older than for younger individuals. The per capita expenditure for the 80-85 age group was already more than twice the spending for all age groups in Canada in 2017. Assuming no change in the prices of inputs to the provision of health care services, the growth in the number of Canadians 65 and older will result in an increase in health care expenditures of approximately 88 per cent from 2019 to 2040.
As we run out of money, ideological dogma has given us one of the developed world’s worst-performing health care sectors. Often, we consider the United States as our only alternative. No one is suggesting we adopt what the Americans have. But in Canada, we don’t have a health care system; we have a queue system. And if Canadians want world-class care, we need to embrace world-class thinking.
Every system around the globe that ranks and operates better – Switzerland, the Netherlands, Germany, Japan and Singapore, to name just a few – has a competitive private alternative to their universal public program. These systems place the patients at the centre of their processes.
Only a model with more public-private competition can give us a more efficient health care system, with more innovation, reduced wait times and care that is superior to what we have today.