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machado: you can't talk healthcare spending without knowing the needs of those who depend on it

there has been lots of talk about the amount of dollars it's going to take to get canada's healthcare system up off of its knees. but to really figure it out, we need to add patient needs into the equation.

by lisa machado

published nov 04, 2023

last updated nov 05, 2023

6 minute read

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6 minute read

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is healthcare giving you that sinking feeling?

funding is important, but money means nothing if it doesn't fill the gutters that patients and caregivers keep getting stuck in. getty

“i’ve got that sinking feeling again,” she said without smiling, leaning back in her chair and folding her hands on her stomach. a group of us had just wrapped up an intense discussion about all the ways the healthcare system had failed us in the last five years, including a painfully delayed hip surgery, a rescheduled screening that resulted in advanced breast cancer and a brother who died in hospital alone. about an hour earlier, the woman had been talking about the canadian national exhibition (cne), an annual fair and longtime tradition in toronto, with cranky roller-coasters run by questionable attendants, impossible-to-win carnival games and greasy (but delicious) beaver tails.

she had said that she wasn’t from toronto, and only ever made the four-hour drive from the small farming community where she lived for two reasons, the cne and her granddaughter — who was now five years old. she said she loved the speed of roller-coasters and the sinking sensation that she got in her stomach as she plunged down steep hills, flew around loop-the-loops and raced through the air upside down. we talked about how her stomach felt like it was sinking because essentially it was — the same as when you are in an elevator that drops downward suddenly or when you miss a step climbing up stairs quickly. your organs, the intestines, stomach, even the bladder, become weightless for a few seconds, shifty, and whatever is inside literally “falls.”

that sinking feeling is a legitimate biological response

but it’s not just wild rides that can bring on that funny feeling in your stomach. as people who had all experienced the shortcomings of health care in scary, life-affecting ways, we keenly identified with that “stomach drop” feeling, except it had nothing to do with fun and adventure. it was those moments after hearing a scary diagnosis or waiting for tests to confirm a suspected life-threatening illness that hit us in the gut — another legit biological response, this time, though, to anxiety and stress.

we were sitting at a table with three other people as part of an event organized by the canadian medical association (cma) — the first of several — to hear what patients had to say about what was needed to fix the system, as well their opinions on public versus private health care. according to the cma, the goal was “focused dialogues to lead informed, constructive discussions to provide insight on how the canadian health system should transform to ensure patients receive equitable, timely access to care and providers thrive in healthy, safe work environments.”

there was a lot that was obvious just minutes into discussions, namely that patients were fed up with a system that continues to disappoint and let them down in significantly damaging and costly ways. and when it came to sussing out the benefits of private health care, no one seemed to have a clear understanding of what it actually meant, besides pushing us into that all-encompassing distasteful and dreaded you-get-what-you-can-pay-for scenario. it was also clear that it was going to take a whole lot more than money to get us to where we want to be in terms of a system that works, is fair, but also compassionate, empathetic and truly knowledgeable of the needs of patients and caregivers.

it was around this time — when the healthcare hole we are in began to seem so big and so deep and so hopeless — that the roller-coaster-loving woman started complaining about a sinking feeling in her stomach, and not at all in a good way.

the lived experience dialogues were just another part of what has been a busy year for debate and conversation about the changes that are needed to buoy a system that was broken well before the pandemic, and is now barely treading water. in february of this year, the federal government announced a $196.1 billion expenditure on health care in the next ten years — including a $46.2 billion boost — aimed at, among other things, alleviating emergency room pressures and screening backlogs.

it was an impressive amount. and yet, the whopping wad of cash on offer didn’t do much to ease the anxiety or boost the optimism of most canadians.

most canadians have low expectations about money improving health care

in fact, in august, an angus reid study done in partnership with the cma found that while the majority of canadians surveyed believed that the money would improve the healthcare system, half of them weren’t getting their hopes up, expecting any positive change to be marginal at best. the feeling was mutual among the majority of healthcare professionals who, while also hopeful about the positive impact that more money could have, felt that we needed more than just dollar bills to mend the countless tears in the system. in terms of what the priorities should be, many identified adequately staffing emergency rooms, decreasing mental health strain on health care workers and reducing waitlists for doctors and surgeries.

health system changing money came up again this week as the canadian institute for health information (cihi) released its national health expenditure trends report showing that ontario is in the top projected spending spot at $126 billion, in front of quebec at $76.8 billion, british columbia at $49.3 billion and alberta, at just over $41 billion. it might have been easy to gloss over these numbers, what with the whole money-for-nothing vibe, except for a linkedin post by the past president of the cma, dr. alika lafontaine, referring to the report:

these are important questions. but it’s worrying that along with building an economic picture by acknowledging measuring market costs, supply and demand, and resources, there’s no mention of those for whom the system is — should be — accountable. funding is important, but as both the cma dialogues and the angus reid findings show, money means nothing if it doesn’t fill the gutters that patients and caregivers keep getting stuck in. and you can’t fill gutters if you don’t acknowledge them, know where they are and which ones are most problematic.

so we need a fifth question (in fact, why not put it first?) that takes the spending analysis a step further and legitimately gives the nod to needs in the spirit of following through on promises to deliver. of course, a good strategy to determine what direction to head in is to seek out the insights of every patient advisory group, advocacy organization and caregiver committee, which according to the advocacy grapevine, is happening in some corners of canada. a starting point could even be the recently summarized findings of the toronto cma lived experience dialogues which concluded that the health care system most people with lived experience want is one that recognizes patients as partners; one that supports the development of more patient advocate positions to not only give a voice to those who can’t speak for themselves, but also alleviate the burden of advocacy among healthcare providers; and one that incorporates patients in health system design, planning, monitoring, evaluation and reform. all of this while providing timely and equal access to care.

does it seem like a tall order? maybe. but how are we ever to know exactly if we continue to blurt out spending plans for healthcare in one breath, along with criticisms and hope, and then talk about patient needs and objectives a few puffs later, in another place and time?

put them together, however, and perhaps the way forward becomes clearer. maybe we can finally stop talking and start acting. and maybe, the next time a patient gets that sinking feeling, it will have nothing to do with their health.

lisa machado is the executive producer of healthing’s advocacy & better health. she can be reached at lmachado@postmedia.com.

lisa machado

lisa machado began her journalism career as a financial reporter with investor's digest and then rogers media. after a few years editing and writing for a financial magazine, she tried her hand at custom publishing and then left to launch a canadian women's magazine with a colleague. after being diagnosed with a rare blood cancer, lisa founded the canadian cml network and shifted her focus to healthcare advocacy and education.

machado: you can't talk healthcare spending without knowing the needs of those who depend on it

there has been lots of talk about the amount of dollars it's going to take to get canada's healthcare system up off of its knees. but to really figure it out, we need to add patient needs into the equation.

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machado: you can't talk healthcare spending without knowing the needs of those who depend on it

there has been lots of talk about the amount of dollars it's going to take to get canada's healthcare system up off of its knees. but to really figure it out, we need to add patient needs into the equation.

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