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Uzelman: The health care crisis - part two

New column from Bruce Uzelman

~BW Uzelman

(Click here to read part one)

The federal government must amend the Canada Health Act (CHA) to promote more effective delivery of healthcare. The CHA establishes criteria for the provinces to receive federal healthcare funding. The current criteria markedly limit the policy options available to the provinces.

In the Fraser Institute report, “Comparing Canada’s health-care system with other countries,” the authors compare Canada to 28 countries with universal healthcare. They conclude, “Unfortunately, the normal Canadian health-care system is characterized by relatively high spending, low resource availability, and poor access to timely care….” Canada ranked 2nd of 28 countries in spending, but 26th of 28 in availability of physicians, and 10th of 10 in the wait for a specialist appointment, as examples.

The CHA is ambiguous, and thus discourages innovation by the provinces, according to a study by Nadeem Ismail and Bacchus Barua, “Is the Canada Health Act a Barrier to Reform?” Most policies in successful universal health-care systems abroad, say the authors, are not specifically prohibited by the CHA, but may be interpreted by the federal government to violate aspects of it:

“For example, a parallel and fully independent private insurance system, for-profit hospitals, dual practice by physicians [in the public and the private systems], activity based funding [for hospitals, as opposed to block funding] are not explicitly prohibited by the CHA, so long as care provided in the public scheme remains accessible to all under uniform terms and conditions and without cost sharing. Nevertheless, each of these could … be interpreted by the government of the day as contravening certain criteria of the CHA.”

Furthermore, the provinces may have avoided these policies to prevent potential financial penalties under the CHA. If the policies are adopted, “The likely result would be improved timely access to quality care regardless of a patient’s ability to pay.”

If the CHA is appropriately amended, it is entirely possible to include private sector participation in the universal public system in Canada, while prohibiting a private pay-for-service system for medically necessary treatment, as in many countries in Europe.

Cost sharing with patients is another tool that the provinces could use to defray some of their medical costs, but the CHA prohibits it. Many countries with universal health care have cost sharing in the form of deductibles or co-payments. It should be an option available to the provinces.

BC, in 2018, introduced Urgent and Primary Care Centres to provide non-emergency treatment, to link the patient with a GP or nurse practitioner and to provide multi-disciplinary care. The Centres also are intended to relieve pressures on emergency departments. The Interior Health region has seven Centres. The clinics do surely provide benefits, but alone cannot solve the problems in BC’s healthcare system.

In conclusion, the federal government restricts policy options available to the provinces to deliver healthcare, while it progressively pays a smaller share of public healthcare budgets. That can not lead to success. It is essential to amend the CHA to expressly allow health-care policies that have proven to be effective elsewhere. The studies cited here, and many others, suggest this may make our universal health-care system more cost-effective, and will produce better outcomes, including more timely care.


Bruce W Uzelman

I grew up in Paradise Hill, a village in Northwestern Saskatchewan. I come from a large family. My parents instilled good values, but yet afforded us, my seven siblings and I, much freedom to do the things we wished to do. I spent my early years exploring the hills and forests and fields surrounding the village, a great way to come of age. My parents owned a successful general store. My siblings and I were required to help out in the business, no choices allowed there!

I attended the University of Saskatchewan in Saskatoon. I considered studying journalism at one point, but did not ultimately pursue that. However, I obtained a Bachelor of Arts, Advanced with majors in Economics and Political Science in 1982.

My career has consisted exclusively of small business, primarily restaurant and retail. I was originally based in Alberta, and then BC, first in Summerland, then Victoria and finally Kelowna (for over 20 years). I was married in Alberta, and we have two daughters, who have returned to Alberta as adults for career reasons, as did my now ex-wife. My daughters are successful, and now have families of their own.

I have maintained a healthy interest in politics throughout my adult years, and wish to put that and my research skills to work as a political columnist.


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