OPINION: Canada has something to learn from U.S. healthcare — but it’s not what you think

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Provinces provide high-quality and safe healthcare for millions of Canadians each year at the cost of almost one-half of provincial budgets. But cracks in provincial healthcare systems are widening.

The most recent statistics show that over five million Canadians don’t have a family doctor and wait times for elective joint replacements and specialist consultations routinely exceed recommended clinical benchmarks.

Public frustration is boiling over, prompting political pivoting in the design of provincial healthcare systems. Alberta’s Health Statutes Amendment Act, Bill 11, opens the door to allowing doctors to bill the public system while also charging private fees and creates an express lane for those who can pay out of pocket, fitting the definition of two-tier healthcare.

Privatization and queue-jumping are not cures for the systemic fragmentation that bedevil provincial healthcare systems. But neither is the status quo. The current system has patients navigating a deeply entrenched maze of disconnected services, resulting in delayed care, duplicated diagnostic testing and worsening symptoms for many.

Kaiser Permanente succeeds because incentives are aligned

If Canadians want a high-performing healthcare system, we should look for motivation to integrated delivery models like Kaiser Permanente in the United States. Kaiser succeeds not because it is private, but because its incentives are aligned. Doctors work in interprofessional teams, digital health records are seamlessly shared, and funding models incentivize keeping patients healthy and out of hospital beds.

Canadian provinces are currently trapped in the exact opposite structure. We pay physicians through fee-for-service models that rewards volume over value. We impose rigid budgets on hospitals that treat patients as expenses. We treat patient data like private business property, leaving vital health records trapped in disconnected computer systems that refuse to talk to each other.

This is where the federal government must step in. For too long, Ottawa’s role has acted narrowly as a cashier for the Canada Health Transfer and only occasionally wagging a finger when provinces violate the Canada Health Act.

It is overdue for the federal government to use its spending power through funding agreements with the provinces to set the strategy, redesign incentives and coordinate federal institutions to drive structural innovation and modernize medicare.

First, the federal government should declare patient health data a public asset.

To copy the data-driven success of integrated healthcare systems, the federal government should tie health transfers to strict rules that force computer systems to connect and share health data. Patient information should flow seamlessly between primary care, hospitals and pharmacies nationwide and lift the financial burden off the shoulders of independent physicians.

Second, the federal government should fund the provinces’ shift to team-based primary care.

The traditional fee-for-service model that pays doctors for each service is burning out doctors and failing to improve access. The federal government should establish a dedicated innovation fund to help medical clinics transition to a team-based model by subsidizing the costs of nurse practitioners, clinical pharmacists and care coordinators to work directly alongside family doctors. By allowing other professionals to handle routine disease management, family doctors are freed up to see more patients.

Dismantle financial silos

Finally, the federal government must help provinces dismantle financial silos.

Currently, provincial funding flows through completely separate and inflexible budgets for hospitals, physician billing and long-term care. This leaves hospitals gridlocked with recovering patients — often designated as requiring an Alternate Level of Care (ALC) — who cannot be safely discharged because there is insufficient funding for community care, like long-term or home care.

Initiatives like Ontario Health Teams stall because they lack the financial authority to move money between these sectors. The federal government should offer targeted or matching funds to provinces that allow regional networks to pool their budgets and reallocate funds. If a network successfully keeps people out of the emergency room or hospital bed, the regional network should be allowed to reinvest savings into local care.

Defending Canada’s single-payer medicare requires much more federal initiative than just fighting two-tier privatization models like Bill 11. Reforming medicare requires building the foundations that create a better public system.

The federal government has the leverage and the capital to help provinces break down data silos, modernize physician pay by redesigning incentives, coordinate federal institutions and foster integrated delivery. It is time for Ottawa to stop funding the fragmented status quo and start laying the foundation for a modernized medicare.

– Jason M. Sutherland is the UBC Professor of Health Services and Policy and Director of the Centre for Health Services and Policy Research in the School of Population and Public Health at the University of British Columbia.

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