It's well known that small and medium-sized businesses are the backbone of the Canadian economy, but it's easy to forget they're also propping up the country's health-care system.
There are tens of thousands of small businesses contributing to the sector in Canada, from start-up ventures developing new technologies, to dental offices and equipment manufacturers, to nutrition and wellness clinics. These companies tend to be overlooked when debate about the sustainability of our public health-care system rages. But a number of voices, from economists to small-business owners themselves, say that co-ordinating and mobilizing health-care businesses could improve the efficiency of the system while contributing to employment and economic growth.
The lack of co-ordination of the small businesses that are interacting with patients – such as pharmacies, clinics, nursing homes, optometrists and dentists – is having an impact on patient care, said Don Waugh, co-founder and chief executive officer of Oakville, Ont.-based startup PharmaTrust, which makes machines that dispense pharmaceutical drugs.
"We have 32,000 companies [in Ontario alone]basically not talking to each other, causing repetition, duplication and discontinuity in the care of patients," he said.
Greg Jones, who teaches practice management at the Dalhousie University Faculty of Dentistry, said dentists are facing many of the same problems that doctors are, but politicians are doing less about it because they don't cover the costs.
"Dentistry, unlike medicine, functions almost entirely in the private sector, so it's not on the government's radar in the same way that medicine would be because they're not responsible for the payment of those individuals."
As an example Mr. Jones cited the fact that 20 per cent of the population, in general, are from economically disadvantaged groups and don't pay for private-sector health care such as dental visits, but they represent more than 80 per cent of cases of dental disease. And, as with doctors, there's a lack of dentists in rural areas.
The concept of the federal government co-ordinating and mobilizing these businesses to better serve the population has never been more timely, as polling shows that health care is the No. 1 election issue for Canadians, even though it is a provincial responsibility.
Combining talk of private businesses and the Canadian health-care system tends to be a non-starter, but the benefits to the broader economy give it great urgency: dental offices, like any professional bodies, support a second layer of companies making instruments and software and other products for them.
"We are in a surprising situation where we do have a huge health-care sector, it's 10 per cent of our gross domestic product," said Don Drummond, former chief economist of Toronto-Dominion Bank. "We have lots of companies that do R&D, we have lots of companies that make pharmaceutical instruments and other hospital care products."
But red tape is a major issue for these small businesses, especially those in health care, to the point where it could be a barrier to entry, said Doug Bruce, vice-president of research at the Canadian Federation of Independent Business. "The problem is that if you have a barrier to entry, you're not going to get any sense of competition out there."
Neil Fraser, president of Medtronic of Canada, cited an example of regulatory overload during a luncheon speech to the Toronto Board of Trade on Tuesday.
He spoke about Ashley Caldwell, a young professional at IBM who went to the United States for Intrathecal Baclofen Therapy (ITB), suggested to help correct extreme stiffness in her legs from a spinal cord injury.
"ITB pump is approved in Canada, but there is very little funding for it in Ontario," Mr. Fraser said in a copy of his speech. "Which is why it was impossible for Ashley to get the device implanted here."
In 2005, he added, the Ontario Health Technology Advisory Committee made four positive recommendations to fund such a device. The following year, a pair of hospitals submitted a business plan to the Ministry of Health and Long-Term Care, and in 2007, an expert panel released a report recommending funding.
"The next year, hospitals were informed of a framework for funding planned for 2009. But then in the fall of 2009, a new expert panel was created under the current Ministry and now, despite all the positive recommendations to date, the latest expert panel has not made any recommendations," he said.
Businesses are not only calling on government to reduce the regulatory burden they face. Mr. Waugh of PharmaTrust argued there should be more government funding for health-care innovation.
"Only 'not for profit' organizations can get funding," he explained. "Private companies are not eligible for [Ontario's]eHealth or Canada Health Infoway funding. We cannot expect innovation until the financing model is fixed so that all stakeholders and participants in our health care system are eligible."