A system in crisis
Hampton: Don’t fix health care, rebuild it
PAUL SCHNEIDEREIT firstname.lastname@example.org @schneidereitp Paul Schneidereit is a Halifaxbased columnist and editorial writer.
Is Canada’s health-care system collapsing around us? Millions of Canadians can’t find a family doctor. Desperate people flood walk-in clinics and emergency rooms. Wait times for procedures can stretch into years. Severe shortages of critical health-care professionals like nurses, and how those shortfalls are managed, are worsening burnout among those still working. Case in point: For years, health-care managers have denied nurses time off and forced them to put in ridiculous amounts of overtime. Eventually, they say “enough” and leave. Elderly patients languish in expensive hospital beds because there aren’t enough spaces or staff at nursing homes. The system — further strained by the pandemic —cannot keep up, resulting in delayed diagnoses of cancers and other diseases, often with tragic consequences. Sorry, not trying to depress you. Those keeping the system running are doing tremendous work, performing millions of procedures annually, improving or saving countless lives. But the reality is our health-care system is in an operational crisis. Yet talks between federal and provincial politicians to discuss health care recently broke down, again, in a squabble over money and priorities. Raise your hand if you want to scream. “There is a second, equally devastating crisis,” Mary Jane Hampton told me recently. “And that’s a crisis of confidence in the publicly funded system. We need to speak to both.” From 1993 to 1996, Hampton was Nova Scotia’s commissioner for health-care reform. During that time, 52 separate provincial health boards were consolidated into four authorities. “There was almost a blind belief in (the health-care system) 30 years ago,” she said. What’s happening now “is really sad and really scary.” No question, faith in what once was a symbol of national pride, our “free” health-care system, has been shattered. She worries private health care will fill the gap. “The danger is (when) people need to pull out their credit cards to access services that they thought they should have had access to through the publicly funded system. The creep is going to be subtle. But it’s already happening,” Hampton said. “You can get a virtual care appointment through Nova Scotia Health, if you’re willing to wait for it, or you can give your credit card to Maple and get an appointment in 10 minutes. Pick one.” There’s only one group of health-care providers, she notes. Still, she’s not against using private sector healthcare capacity if it’s paid for by the government. “But that needs to be a deliberate decision about how to leverage private sector resources to strengthen the publicly funded system, not to have the private sector strangle the publicly funded system.” What many people -– including some politicians, even health-care planners — don’t get, Hampton said, is the old health-care system isn’t fixable. That’s because it’s already gone, she said. “The system that we romanticize about is half a century old … (but) really doesn’t exist anymore,” she said. “We spent between the 1990s and today trying to figure out how to shoehorn an old job into new models of care and it doesn’t work. “You can’t just move bits and pieces around and think that that’s going to solve problems, because everything has changed. Scopes of practice have changed. The way people expect to be able to access care has changed." Take, for example, family physicians. Back in the day, “a family doctor was the person who delivered your child, buried your parents and everything in between,” Hampton said. “It was by rare exception that you would find yourself in the care of a specialist because the family doctor did pretty much everything. … They ran community hospitals. They did surgery. They did anesthesia. They did everything.” Today, family physicians are specialists, but many governments, including Nova Scotia’s, have historically not wanted to pay them that way. Newly licensed doctors routinely carry substantial student debt. It’s no surprise most are not interested in taking on an old-style family medical practice. The still dominant feefor-service payment model, which pays family doctors per procedure or office visit, is a “bean counters’ model,” Hampton said. Instead of assuming 99 out of 100 family doctors will act appropriately, the system unfairly assumes those physicians will try to cheat, she said. “Every province over the last 50 years designed funding models assuming that physicians are going to work the system to the disadvantage of the taxpayer,” Hampton said. “It’s not surprising that you end up with a really sucky funding model half a century later.” She lauded British Columbia, which recently announced it will ditch feefor-service in the new year and pay family doctors substantially more. “It’s going to set the bar for the rest of the country.” So, how do we solve this crisis? Where do we go from here? “I’m really hoping that people have figured out that the end game isn’t to fix the system. It’s actually to build one,” she said. “What we need is a Canadian health-care system. We don’t have that. And honestly, we never did. I mean, we had a patchwork of provincial and territorial programs. “But as a Canadian, you should reasonably expect to have access to the same standard of health care, from Labrador to Victoria. “If we didn’t learn any lessons from COVID, and the wackiness of having every province and territory follow its own rules around an issue of a pandemic, … (about) why a national approach to basic health system infrastructure and programming is necessary, then I give up.” Politicians must stop talking about money first, she said. “Conversations actually need to be much more fundamental in principle than that. We need, first of all, to get everyone on the same page as to what is the shared vision for what the Canadian health-care system would look like.” To end this column on a bright note, Hampton thinks Nova Scotia could be a leader in making that change happen. “We’ve got a million-plus people. We’ve got one health authority, plus the IWK. We’ve got a medical school. We’ve got research and innovation, investment. If anyone could pull it off, it should be Nova Scotia.” To Hampton, “the greatest risk” now is public exhaustion. “People are beginning to lose faith. That's also an issue that the premier and his team are going to need to address head on. They need to be more than cheerleaders. “People need to see what the end game could look like.”