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opinion: canadian healthcare choke points put patient lives at risk

canada’s healthcare system is strained. it was always strained. it was designed that way.

by dr. david j stewart

published nov 16, 2023

4 minute read

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4 minute read

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opinion: canadian healthcare choke points put patient lives at risk

canadian emergency departments are now overwhelmed due to too many sick canadians having to wait too long at chokepoints. getty images

canada’s healthcare system is strained. it was always strained. it was designed that way. the united states healthcare system has excess capacity. costs are constrained by insurance companies requiring pre-approval before non-emergency interventions. physicians and hospitals typically have several employees tasked with ongoing communication with insurance companies. this is inefficient and costly.

in canada, costs are constrained by numerous choke points. numbers of hospital beds, operating rooms, ct/mri/pet scanners, training positions for physicians, nurses, and support staff, and the budgets to operate all of these are tightly controlled by government. it is much easier to control costs using the canadian approach (limiting supply) than the american approach (limiting utilization of available supply).

healthcare resources provided by provincial governments are usually less than those needed. while this reduces spending, it leads to the potentially dangerous situation of patients having to wait. and costs escalate as patients become sicker.

emergency departments have been safety valves for patients deteriorating while waiting. this approach has somewhat worked for acute issues. but canadian emergency departments are now overwhelmed due to too many sick canadians having to wait too long at choke points. and for elective issues, for example, hip replacements, dermatology appointments, you may wait one to two years.

waiting is unacceptable for cancer

waiting is unacceptable for cancer. there is a real risk that a curable cancer will become incurable while waiting. and those with incurable metastatic malignancies may deteriorate to the point they can no longer even receive therapies that could alleviate suffering and meaningfully prolong life. visiting emergency departments may get you through one choke point, but not the several others you must traverse before initiating therapy. consider this: differences in u.s. and canadian survival rates indicate that of the 84,600 canadians who died from cancer in 2021, approximately 11,400 might have survived if they had as rapid access to diagnostics and therapy as the average american.

cancer screening saves lives by early detection. but if a patient’s cancer is detected by screening, they must subsequently clear choke points that delay biopsy, staging and therapy initiation. they compete with patients whose cancers were discovered, not through screening, but from symptoms. both screened and symptomatic patients suffer at these choke points.

delayed scans can mean toxic therapies

patients with incurable cancers can benefit greatly from effective therapies. while on these therapies, scans are done regularly. therapies are stopped if the cancer is growing despite therapy. but scans are often delayed. scan choke points mean that expensive, potentially toxic therapies are continued when a comparatively inexpensive scan (if available) would show they should stop.

effective new drugs can improve cancer patient suffering and meaningfully prolong life. but on average, canada takes twice as long as our peers to publicly fund effective new medications. between 2012 and 2021, we ranked a dismal 22 out of 29 of reporting oecd countries in the proportion of new drugs that were publicly funded. we beat mexico and turkey, but not by much. this funding choke point means canadians suffer and die while being denied access to therapies that might help them if they lived elsewhere.

but loosening some choke points will accomplish little — patients will then just be stuck at many later choke points on their road. we need to loosen all of them.

from 1985 to 1990, canada ranked fourth internationally in terms of healthcare spending per capita and seventh on life expectancy. by 2020/2022, we ranked 12th on health care spending and 16th on life expectancy. it is projected that we will rank 27th on life expectancy by 2040. are any of us ok with this? our loved ones deserve better than that.

experience tells us that system redesigns will not fix canadian healthcare. in the past, as the benefits of redesign efforts have begun to kick in, governments have typically cut budgets, gutting key components essential to making the redesign work.

money alone will not fix this, but money is an essential component. we must either spend more, or else accept rapidly deteriorating healthcare. you get what you pay for. to increase per capita healthcare spending to match countries with second, third or fourth highest spending (switzerland, germany, and norway) would mean increases of 27.4 per cent, 26.8 per cent, or 23 per cent, respectively. we could do this either from increased taxes and reprioritizing public expenditures or from increasing healthcare privatization. but increased privatization is not an effective option if governments just use it as an opportunity to further limit their contribution so that choke points remain unimproved.

yes, canadian healthcare is strained. but it was designed that way.

dr. david j stewart is an ottawa medical oncologist and author of “a short primer on why cancer still sucks” (amazon books). he writes on behalf of “physicians for improved access to health care,” which includes: dr. sandeep sehdev, medical oncologist, university of ottawa; dr. alan kaplan, family physician, aurora, ontario; dr. gerald batist, medical oncologist, mcgill university; dr. paul wheatley-price, medical oncologist, university of ottawa; dr. shaun goodman, cardiologist, unity health, toronto; dr. silvana spadafora, medical oncologist, algoma district cancer program; and dr. joanna gotfrit, medical oncologist, university of ottawa.

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