Healthcare Under Pressure

Healthcare.
Under pressure.

While the publicly funded healthcare system is viewed as a source of national pride, recent studies suggest we are not achieving value for money.

Investments and reforms have resulted in only modest improvements in health and healthcare reflected in Canada’s low ranking among comparator countries.

  • On overall health system performance, Canada ranked 9th among 11 high-income countries (10th on access; 9th on equity; 9th on health care outcomes)1
  • 4 of the top 5 countries for overall system performance (UK, AUS, NZ, NOR) spent less than Canada on healthcare2

Fragmented and uncoordinated services leave patients navigating a complex system of healthcare silos.

Service provision is overwhelmingly by the independent sector leaving no one holding accountability for a patient’s journey. Policy makers today struggle to address long wait times, inequitable access and poor health outcomes for vulnerable populations.

Canadians wait for healthcare; Canada ranked3:

  • last for same day/ next day appointments
  • second last for access to after-hours care
  • last for timely response to communications from their regular doctor
  • last in wait time to see a specialist

Inequalities in access to care and outcomes persist (and are widening in many cases):

  • Hospitalization rates for COPD, a leading cause of morbidity and mortality, are 3.1x higher for Canadians in the lowest income quintile compared with the highest income quintile (10 years prior the ratio was 2.6x)
  • Fair/poor self-rated mental health increased for all but the highest income quintile (increasing 49.9% for Canadians in the lowest income quintile)
  • Aboriginal children experience higher rates of infant mortality, youth suicide, childhood obesity and diabetes and lower rates of immunization and access to a doctor
  • Coordination of care is inconsistent; Canadian primary care physicians wait the longest to receive discharge information from hospitals (22% waited more than 15 days)

Canada’s healthcare (not) online; Canada ranked8:

  • 3rd last for access to online health information
  • last for email communication with regular healthcare practice

Money alone does not buy change, only more of the same at a higher cost.

Fiscal constraints and an ageing population further stress a system already under pressure. Healthcare delivery needs to be reorganized to be more responsive and provide better value improving access, equity and quality. 55% of Canadians believe fundamental changes to the health care system are needed, higher than all seven other OECD countries surveyed9.

In a universal healthcare system, the idea (ideal?) is pretty well understood: one system, serving all people, at the highest levels.

Big questions lie ahead. Complex (and bold) ideas that challenge the status quo will be required to come up with equally big answers.

Invictus Analytics and Strategy has the perspective to help healthcare leaders in Canada wrestle these questions and find the unexpected, consequential answers.

1 The Commonwealth Fund, “Mirror, Mirror 2017: International Comparison Reflects Flaws and Opportunities for Better U.S. Health Care,” July, 2017.
2 ibid
3  CIHI, “How Canada Compares – Results from the Commonwealth Fund’s 2016 International Health Policy Survey of Adults in 11 Countries,” Chartbook. February, 2017.
4 CIHI, “Trends in Income-Related Health Inequalities in Canada,” Summary Report, 2015.
5 ibid
6 Greenwood, M.L., et al. “Social determinants of health and the future well-being of Aboriginal children in Canada,” in Paediatrics Child Health, 2002.
7 CIHI, “How Canada Compares: Results from the Commonwealth Fund 2015 International Health Policy Survey of Primary Care Physicians,” January 2016.
8 CIHI, “How Canada Compares – Results from the Commonwealth Fund’s 2016 International Health Policy Survey of Adults in 11 Countries,” Chartbook. February, 2017.
9 Papanicolas, I., et al. “Health Care Spending in the United States and Other High-Income Countries,” JAMA Special Communication, March, 2018.