If you’re tired of the haggling between health ministry bureaucrats and doctors over fee cuts and health costs, be patient and pay attention. This is more than a ritual dance about money and working conditions. And the haggling does affect you, directly.
If you’ve had a harder time getting in to see your doctor in a reasonable time, if you’ve been re-scheduled again and again for an elective (albeit painful) back or hip procedure, or the family physician you have been seeing for 20 years moves away, you’re getting close to the nexus of why these interminable negotiations between the blue suits and the white coats have become so heated.
All provinces are strapped by mounting healthcare costs which now consume 40 cents out of every tax dollar you pay.
With Canadians enduring ever-longer wait lines for medically-necessary care, with emergency rooms and acute care beds jammed at unsustainable levels, healthcare bureaucrats have traditionally tended to clamp down on fee reductions for physicians as one means of health care cost restraint. Doctors are soft targets. Health ministry bureaucrats know that physicians do not want to “drop tools” and walk away from patients who depend on them for the health of their families.
At present, of all developed countries with universal comprehensive health care systems (that excludes the US), Canada is among the top five most expensive in terms of its share of gross domestic product (GDP) spent on health care.
Yet, of 36 countries whose economies are tracked by the Organization for Economic Cooperation and Development (OECD), Canada ranks in the bottom 4 or 5 in terms of acute (curative) hospital beds per thousand population, and practicing physicians per thousand population.
Same story for high tech: in 2015 Canada had 9.5 MRI units per one million population—that was 13th out of 36 (OECD), about the same as Chile and Turkey. By comparison, Australia had 15 per million, Germany 30.5, US 39, Japan 51.7.
Of Canada’s $228 billion estimated health care spending in 2016 (11 percent of the GDP, $6299 CAD per person), where is all that money going?
Doctors, and healthcare analysts are increasing looking to bureaucrat bloat as a major contributor to the costs of healthcare in Canada: partly to their constant efforts to set up layers and administrative structures to regulate healthcare professionals, and partly by spawning their own numbers.
In a highly informative, and provocative blog, Canadian family physician Dr. Shawn Whatley notes that between 1990 and 2013, Ontario had closed some 17,000 hospital beds, yet the province has not cut a similar number of bureaucrats.
He also notes that Ontario currently has 1.7 acute care hospital beds per 1000 people—half the average for other OECD countries.
Dr. Whatley also cites original research by Matthew Lister, Senior Director Strategic Planning with the Ontario Medical Association which reveals that Canada’s 32,000 healthcare bureaucrats account for a ratio of 0.9 such bureaucrats for 1000 population. By comparison, Sweden has 0.4 healthcare bureaucrats per 1000 population, Australia 0.255, Japan 0.23, and Germany (one of the most effective and efficient systems tracked by the OECD) has but 0.06 per 1000 population.
As Dr. Whatley summarizes, “Does it make sense to have so few beds and so many bureaucrats?”
I also suggest we could use a study to compare the average and median salaries of healthcare bureaucrats vis a vis the real, actual “take home pay” of family physicians and even other specialists?
To be fair, the raw numbers of hospital beds per thousand, or physicians per thousand, are not necessarily good indices of health care quality or access. Fewer beds properly used, or fewer physicians better located and incentivized can have a far more salutary effect on the quality of care received by patients.
But given the growing wait lines, the logjams in hospital waiting rooms and acute care beds, and the constant haggling about fees and other restraints on healthcare professionals, attaining that quality in Canada remains elusive.