Hospitals should be run by the experts, not politicians
Canada’s health-care systems are deteriorating.
Wait times in the country’s emergency rooms have been going up. In Quebec, they’ve increased by 42 minutes over the past five years.
Waits for specialist treatment are also awfully long. Last year, one in two Canadian patients waited over six months between referral from their general practitioner and actually getting their treatment from a specialist.
Access to a family doctor isn’t getting any easier, either. Currently, more than 6.5 million of us don’t have one. That’s roughly one in six Canadians.
The fact is our health-care systems are struggling to provide us with the medically required care Canadians need and deserve.
It doesn’t have to be this way.
When we look at other countries with universal systems, a great many of them perform better than Canada in terms of access and health outcomes.
In an oft-cited ranking of health systems from the Commonwealth Fund, we rank 10th out of 11, ahead of only the United States.
European nations, where universal access is guaranteed, just as it is here, rank higher than us. For example, France is eighth, Germany is fifth, and the Netherlands is second.
One thing these systems have in common is that they’ve allowed private, non-profit hospitals to operate as part of the national health system.
In France, these account for 14 per cent of hospital beds. In Germany, it’s 28 per cent. In the Netherlands, it is 100 per cent.
A good part of their success is due to the relative autonomy these hospitals enjoy in their management.
Unlike in Canada, where things like procurement and collective bargaining are typically determined at the provincial level, independent non-profit hospitals are empowered to make those decisions locally.
This brings decision-making closer to the front-line staff who deal directly with patients, which ends up better reflecting the reality on the ground.
After all, who is better positioned to know whether or not a regional hospital needs a new imaging machine? Is it front-line staff and local administrators, or provincial health bureaucrats far off in the capital? Or, for that matter, politicians on the campaign trail?
The latter question might seem preposterous, were it not for the fact that elections have been fought over similar promises in recent memory.
Right before the 2021 election campaign began, Newfoundland and Labrador’s Liberals made a splash by promising to purchase a $2-million PET scanner for Corner Brook, despite the health minister insisting just a week earlier that such a machine would be of little use.
By removing centralized political control over facilities, independent non-profit hospitals are able to better allocate their funding to the sectors with the most pressing needs, rather than those that make for the best photo shoot.
Another part of their success can be tied to how these hospitals are financed, as different funding methods tend to encourage different administrative behaviours.
In Canada, hospitals are primarily funded through what is called block funding.
In essence, once per year, the Department of Health evaluates how much funding it estimates a hospital will need based on the previous year’s level of activity. Once that funding is received, hospitals have to use it sparingly over the course of the year so as not to run out before they get their next big cheque.
Under this system, any patient coming in is a cost to the hospital, which is then incentivized to ration care through long wait times.
In European health-care systems, hospitals are primarily funded through an activity-based funding model, whereby a hospital receives money from the government for every medical act performed.
As every act of care is tied to a direct source of revenue, hospitals are encouraged to see and treat more patients in order to increase their funding. This helps create healthy competition between hospitals, which seek to attract patients with timely, quality care.
Instead of letting politicians and bureaucrats micromanage facilities from our provincial capitals, we should empower front-line staff with better local control over our health-care facilities.
Allowing independently run non-profit hospitals to play a role in our universal system would achieve just that.
Emmanuelle B. Faubert is an Economist with the MEI and the author of “Non-Profit Health Care: Taking Inspiration from Europe.” The views reflected in this opinion piece are her own.