Telemedicine works. Don’t let government near it

Parents know this all too well: When your kid wakes up with a fever, mornings turn into a scramble to get out the door as fast as possible and head to a clinic. After all, if you don’t get in line before it opens, your chances of seeing a doctor the same day dwindle. Long hours spent sitting on waiting room chairs may be your child’s first memories of Canada’s health care system.

These days, however, thanks to telemedicine, many Canadians no longer have to wake up at the crack of dawn to secure a spot at the clinic. Nearly 10 million Canadians now access a physician this way, among them no doubt many of the more than six million who do not have a primary care physician. Costs of a consultation — which are often covered by insurance — range between $50 to $100. For individuals who live in remote areas or have mobility issues, virtual care is the easiest way to receive timely treatment.

But this convenient way of accessing care may be coming to an end. Right now, telemedicine is mostly covered by employers and private insurance. The federal government has announced plans to “crack down” on telemedicine by forcing provinces to cover its costs. It wants telemedicine to be absorbed into the government-run health care system.

You may wonder how the federal government can dictate health policy this way, since health care is a provincial jurisdiction. It does so by adding conditions to its fiscal transfers, leveraging the billions of dollars it sends to provinces to get them to do what it wants. In the case of telemedicine, if provinces do not comply, Ottawa has threatened to impose the usual Canada Health Act penalty and reduce federal health transfers by the amounts involved.

In addition to violating the constitutional division of powers, shifting telemedicine costs from private parties to the provinces is fiscally untenable. Either provinces go deeper into deficit or they divert their already limited resources from priorities they consider more important. Quebec alone will spend $61.9 billion on health care this year. That’s $5 billion more than it collects through income and corporate taxes.

Telemedicine is one of the few parts of health care not plagued by lengthy wait times. In theory, integrating it into our dysfunctional government-run system will add benefits to the system; in practice, it seems more likely telemedicine will inherit the system’s problems.

It’s a matter of incentives and organization. Whereas telemedicine providers are hyper-focused on one aspect of health care, our provincial health care bureaucracies are constantly putting out fires all across the system, such as: the more than one in 10 emergency room visits last year that ended in patients getting discouraged and leaving before being treated; or those six million Canadians who still don’t have access to a family doctor; or the exceedingly long wait lists that have come to characterize our surgical wards.

When government administrators choose where to allocate the limited new resources they have at their disposal every year, there’s a good chance they might prioritize any of those areas at the expense of telemedicine, leading to worse and worse telemedicine service.

Telemedicine complements and helps ease the burden on our government-run system. A comprehensive review published in 2016 on the impact of telemedicine found that “low-cost telemedicine interventions in primary care are feasible and acceptable to both patients and physicians, typically resulting in improved quality and cost savings.” According to the president of the Conseil pour la protection des malades, 40 per cent of minor ailments are treated through telemedicine when it’s available.

Telemedicine is one of the very few aspects of our health system that works. Ottawa’s desire to put it in the hands of government administrators risks bringing it down to the performance level of the rest of the health care system.

Sixty-five per cent of Canadians currently report that accessing timely health care is “difficult or impossible.” But the same number stated that someone in their household has used telemedicine to contact a health care professional. Telemedicine is popular: 78 per cent believe the use of virtual care should be encouraged. Canadians are clearly open to expanding it.

Canadians’ relationship with their health care system is fraught with constant self-bargaining. We ask ourselves if we are sick enough to justify missing a whole day of school or work just to sit in an ER or clinic for hours. The federal government aims to keep health care cost-free, but we end up paying with our time. Waiting is a cost, and putting an end to telemedicine would be cutting a vital lifeline of care.

Daniel Dufort est président et directeur général de l’IEDM. Il signe ce texte à titre personnel.