Healthcare Reform Is Not Yet on the Horizon

Healthcare reform is on everyone's lips these days. persistent calls for a “difference” and “change” are becoming louder. But will these calls reach a tipping point and precipitate fundamental changes in how provinces design healthcare delivery and how they pay for it?

A number of complex and related issues may signal that meaningful healthcare reforms are afoot. There needs to be a proverbial “burning platform” that would make the political risk of overdue reforms palatable to the provincial and territorial governments responsible for healthcare delivery and quality. There also needs to be a source of money to fund provinces' reforms. Finally, there needs to be some sort of a détente between governments' perspectives of federal involvement in healthcare.

The Burning Platform

Does the current status of healthcare delivery represent a burning platform for change among the political class? That is debatable. Accessing a family doctor has been difficult for many Canadians for years, and waiting for planned surgery in provinces' hospitals has been a decades-long problem. These enduring challenges have not triggered reforms in the past, although they are worse today than they have been in recent memory.

There may be other problems that create a burning platform. Perhaps the least likely among these are the provincial medical associations and nurses' unions. Both are unarguably influential in provincial capitals, yet they have not been clamouring for or using their leverage to initiate a massive overhaul of provincial healthcare delivery. Rather, and perhaps rightly centred on their members, their focus has been on more money and hiring more people.

The more likely spark of the burning platform will come if and when doctors leave provincial health insurance programs or people die in avoidable ways. It is possible that family doctors will opt out of provincial medical insurance programs en masse, such as the Ontario Health Insurance Plan or BC Medical Services Plan – and create more and larger “concierge” medical services companies that operate outside the province's programs and policies, leaving fewer options for residents. Alternative sparks may include medical tragedies, taking the form of failed triages in emergency departments, excessive delays in treating cancers or missed hand-offs in life-saving situations. Minus these events, the burning platform may not be “hot” enough for the political risks of healthcare reforms.

The Money

Another pillar of healthcare reform is funding. There needs to be a very significant source of money to patch over “rough” spots in the delivery system's reform. The magnitude should be in the range of $40 billion for several years as a starting place, and it should be noted that this amount is probably an underestimate (Sutherland and Forest 2021). However, as healthcare spending approaches 45% of the provincial spending, new massive spending by provinces on healthcare would mean a significant increase in provincial taxes or deficits.

The other possible source of funding could be a deep-pocketed federal government. The federal government, however, has let it be known that it does not want the same old. Unlike unmeasured goals and lack of accountability inherent in the health accords and bilateral agreements, one should expect federal money to come with strings, possibly for buying measurable, effective and patient-centred change in healthcare delivery in provinces and territories. The federal government also wants some of the credit if it puts up the money.

The Politics

For provinces' governments, accepting conditions and sharing credit are both tall orders. This tension points to the barrier of federally funded healthcare reform: political alignment between the federal government and the provincial governments' willingness to accept conditions in return for federal money. Due to the distance between federal and provincial or territorial political ideologies regarding federal involvement in healthcare delivery in some settings, federal–provincial disputes may be unavoidable, and threading the needle between ideologies will be daunting (McIntosh and DeCorby 2022).

In my opinion, the elements that would trigger a meaningful healthcare reform are not yet in place. There is neither a burning platform nor a large pot of provincial money, and there is no commonality of interest between federal and provincial governments on positions of federal involvement in provincial healthcare delivery. Until there is a change in one or more of these three pillars, I do not expect much in the way of massive reform. However, these things may change on a dime.

In This Issue

This issue is led by a research article focusing on the implications of patents on medicine–device combination products. Based on analyses of patent information, this study, authored by Beall et al. (2022), found device patent filings to be more common in Canada, suggesting that there is increasingly more attention given to upgrading delivery devices. The findings have immediate implications regarding whether pharmaceutical manufacturers have developed new or novel devices to deliver old drugs with marginal health benefits to the patient versus significant innovations that actually improve health.

Kornelsen et al. (2022) present a scoping review of the structure and function of rural health councils from the perspective of including patients in healthcare planning and decision making. The review found a number of common themes, including the ability to participate equally, the need for transparent processes and ensuring accountability for decisions. The authors conclude that for efforts to include patients and community members in rural healthcare planning and decision making to be successful, municipal, regional and provincial collaboration is required.

A comparative study between the hospitals in Ontario and European countries by Ivanković et al. (2022) assesses the extent to which performance data are used for decision making. Using a cross-sectional survey of hospital managers, the results find that Ontario hospital managers used performance information for decision making more than their European peers. The study highlights the ability to compare countries' hospitals and outlines barriers to incorporating data into decision making.

The final article in this issue explores how Ontario homecare workers were affected by changing emergency policy measures introduced during the COVID-19 pandemic. Using a qualitative design, this study by Hopwood et al. (2022) reports that new policies focused on rapid recruitment, education and training. The study found that these policies exacerbated concerns regarding consistency in training and education, though noting that more policy research is needed to address systemic issues inhibiting durable homecare workers' employment.