Is health care burning in Canada?

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Provincial governments need to show courage and co-operation as the solution to better health care actually lies in interprovincial cooperation and a focus on health, not just money.

By Sheila Copps
First published in The Hill Times on August 15, 2022.

OTTAWA—Is health care burning in Canada?

Professionals leaving in droves think so, and so do provincial premiers seeking a major cash infusion from the federal government.

The issue is front and centre in Ontario after the Doug Ford government promised to review all options in tackling health-care problems.

Privatization is on the table, along with all other “innovations and opportunities,” according to Ontario Health Minister Sylvia Jones.

Jones was in the hot seat after the Progressive Conservative government announced that it was looking at all options in an effort to fix the system.

Jones revealed that she has been in talks with hospital corporations across the province in an effort to solve the problem.

But that statement alone is a glaring example of how the system will not be fixed.

As long as the health-care system is strictly based on improving hospital care, it will not tackle the issue of wellness.

And the incorporation of multiple hospitals’ systems is actually part of the problem.

At the moment, Ontario has 141 public hospital corporations spread across 217 sites.

According to a 2021 report from the Economic Research Institute, the average salary of hospital CEOs in Ontario was $600,000.

That figure was up to six times higher than the average CEO salary in most not-for-profit industries and compares very well to a prime ministerial salary of $357,800.

In comparison, the average salary of a long-term care facility CEO was $106,000.

The problem is not just a money issue. It is an organizational issue.

In the world of informatics, every hospital corporation has its own authority to develop information collection with absolutely no requirement for interoperability.

For example, in the city of Ottawa, patients are saddled with two different applications depending upon which hospital they may have been treated at.

Neither hospital applications will cross-pollinate, leaving patients to log into two separate and complicated websites for follow-ups on test results or appointment information.

We have known for years that thousands of hospital beds are occupied by chronic-care patients who should be in retirement homes, but the shortage of those beds is so acute that the hospital has become a substitute chronic care facility.

Hospital corporations also do their own buying. The economies of scale that should apply in a public system do not exist.

Some hospitals form regional groups in order to benefit from more attractive purchasing power. That is another cost that could be reduced if there was an integrated informatics and buying system for the whole province.

More attention should be focused on community care supports to keep people out of hospital. That is not going to happen when the main leaders in the debate are hospital corporation presidents.

The second issue that needs to be tackled is the lack of portability in the Canadian health-care system.

Each province guards its authority aggressively, hence there is very little sharing of health information cross-provincially that could assist in tackling root issues of illnesses in Canada.

Provinces claim it is all about the Constitution, but they do not hesitate to blame the health-care problems on federal underfunding.

During the height of COVID, we saw what could happen when provinces work together with the federal government.

We had bulk-buying of vaccines and ancillary COVID-fighting equipment. That move alone kept the costs of vaccines, tests etc. down to a reasonable number.

Why not apply that same purchasing power to regular medical challenges?

Surely, innovation should involve all these hospital corporations banding together to cut costs and apply some of those savings to hospital worker salaries.

Worker retention should be a top issue, and that goes far deeper than simply in hospitals.

That is a solution that needs to include community health-care workers and those whom we have cited with great pride as the front-line crisis workers in retirement and long-term care facilities.

If the “innovation” discussion is strictly limited to the hospital care sector, we will fail once again to tackle the root of the problem.

And if each province is simply patching its own system without considering the value of informatic interoperability between jurisdictions, we will continue to offer 19th century solutions to 21st century problems.

In the new world of cyberspace, every single Canadian could have access to their own health care record from cradle to grave.

Provincial governments need to show courage and co-operation as the solution to better health care actually lies in interprovincial cooperation and a focus on health, not just money.

Sheila Copps is a former Jean Chrétien-era cabinet minister and a former deputy prime minister. Follow her on Twitter at @Sheila_Copps.