Healthcare Systems

Nowhere in the world do public health systems appear to be working. The COVID pandemic has proven what many already knew; that medical services in most countries were and remain woefully equipped and prepared to deal with current realities and with crisis situations. 

In my opinion governments exist to fulfill four basic functions: to provide an economic infrastructure capable of creating order and sustaining jobs, to provide security, to provide health care, and to provide education. The rest is icing on the cake, yet governments around the world regularly waste precious resources on capricious programs and projects that serve parochial interests at the expense of these four basic necessities.

With respect to health care, I will use Canada as an example since it is a purely public health system as opposed to other federations such as Germany, Switzerland, and Spain, where medical coverage is a public/private mix and different levels of coverage exist depending on how much the individual is willing to pay for insurance. 

The Commonwealth Fund’s 2021 report comparing the healthcare systems of 11 developed countries ranked Canada in 10th place, ahead of the United States, which was at the very bottom. Finishing ahead of the U.S. is nothing to be proud of, contends Dr. Paul Woods, a former president and CEO of London Health Sciences Centre.

As a federation, the Canadian federal government is responsible for funding the program, but the provincial governments are responsible for managing their health care systems.

But is the problem only funding?

The Canadian healthcare system was designed back in the 1960’s when patients required mostly acute, short-term care. With an aging of the population and bad eating and lifestyle habits, an increasingly greater number of patients now require long term, chronic care which is more costly, and which places a greater financial strain on the system.  

Indeed, public satisfaction with hybrid models appears to be higher in Europe than in Canada or the United States. This could well be a model worth reviewing by Canadian authorities in this century where the realities of medical necessities are different and where what worked sixty years ago is simply not effective today.

As it stands, healthcare now takes almost up to 45% of provincial fiscal budgets but even so, 14% of Canadians currently do not have access to a primary care physician. According to the Fraser Institute, Canada is in the midst of a physician and nursing shortage which will likely grow more acute in the coming years without a rapid influx of foreign trained physicians as well as increases in nurses’ salaries to preclude the current exodus to the U.S.. 

For general practitioners and family physicians, over the period 2019-2028, new job openings (arising from expansion demand and replacement demand) are expected to total 50,900, while 19,400 new job seekers (arising from university graduates, immigration and mobility) are expected to be available to fill them.

Despite this, it is difficult for foreign trained physicians to become accredited in Canada. Consequently, it appears that accreditation is there to protect the interests of home-grown doctors and nurses rather than those of patients. This leads to many would-be doctors with foreign training working at menial jobs because they are not certified to practice in Canada.

For example, in 2020 Reuters reported that Claudia Avila, 39, an obstetrician and gynecologist with 11 years of experience in her home of Venezuela, emigrated to Canada with her husband and daughter four years ago.

For Edmonton area-based Avila, it took years of saving to pay for the costly exams and preparations. Then, the regulations changed and she had to start over.

A responsible loosening of these regulations could provide many more doctors and nurses to help meet demand.

Countries that have purely socialized medicine face the same dilemma: the inability of government alone to efficiently provide the breadth and depth of medical care required citizens.  

Political leaders in countries where dissatisfaction is rife must actively seek new ideas and models, and challenge current assumptions. One place to start would be to develop future healthcare strategies taking lessons learned from the pandemic and seeking best practices from public, private or hybrid models. 

Such strategies would also certainly need to focus on bureaucratic standards, practices and enforcement to improve efficiencies, how to better develop, certify and pay doctors and nurses while reviewing and updating practices to ensure effective patient care and the safe and efficient flow of services.

Indeed, by liberating the system from servicing all the needs of all patients and allow those with resources to seek private insurance and treatment, those who cannot afford private medicine would likely enjoy far better service than they do now.

Better service and responsible spending are what citizens are demanding. 

Governments everywhere have an opportunity to rise to the challenge to reengineer public medical systems and develop new ideas and models that can deliver better results. 

As aging populations place an even greater strain on medical facilities, failure or unwillingness to address these challenges by thinking outside of the box and abandoning old models that are no longer fit for purpose is essential. 

Absent such a revolution in thinking, the current situation may well further exacerbate public confidence in the ability of governments to address such a critical issue effectively and efficiently. 

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Edición: Laura Espejo