The Canadian healthcare system is often spoken of in a controversial manner, even among Canadians. There are arguments about whether it’s cost, quality and access are up-to-par with other developed countries. Since the Affordable Care Act was signed into law by President Obama in 2010, comparisons between Canada and the US have become more prominent and one of the most common talking points between the two is wait times. Waiting for medical care has become a defining characteristic of the Canadian system, and it’s only getting worse through mismanagement of funds, physician shortages, and slow technology adoption. But telehealth seems to be a promising solution to this problem.
Let’s quickly set the landscape. How does the Canadian healthcare system function? In 1984, the Canada Health Act (CHA) was passed, establishing criteria on portability, accessibility, universality, comprehensiveness, and public administration. The goal of Canadian Medicare is to offer “universal coverage for medically necessary healthcare services provided on the basis of need, rather than the ability to pay.” Medical services are funded through federal, provincial and territorial taxation, such as personal, corporate and sales taxes. The CHA’s criteria for health insurance plans must be followed by provinces and territories, and the federal government serves as a gatekeeper for financial support. As of 2010, the private sector accounted for 30% of total health expenditures.
Nearly every Canadian has a wait time-related story. Long wait times are so common that, in 2018, more than one million Canadians incurred a conservative estimate of $2.1 billion in private medical costs, or $1,924 per patient, due to lost wages and reduced work productivity. As the demand for medical treatment grows and the supply of medical professionals drops, those numbers will increase exponentially in the coming decades.
Despite this harrowing reality, Canadians seem to be split on whether these excessive wait times are reasonable for a universal health system. The Commonwealth Fund’s 2016 Health Policy Survey reports that supporters of the current system believe wait times are “a small price to pay for universal healthcare.” But when we compare Canada with other countries in the Commonwealth Fund’s survey, it’s clear that wait times are not characteristic of universal healthcare. In fact, the survey revealed that 18% of Canadians waited four months or longer for elective surgery, compared to 4% in the Netherlands, 2% in France and 0% in Germany.
The Fraser Institute reports that the average wait time, from your general practitioner’s referral to treatment, is 19.8 weeks. So, why are wait times so high in Canada? There are many reasons worth looking at. A few of them include:
- Funding. Canada has been funding hospitals on the basis of past expenditures rather than a value-based model, which is being popularized by American healthcare. This would allow hospitals to receive appropriate funding based on the quality of medical procedures and hospital readmission rates. This payment model holds medical professionals accountable and ensures that positive long-term patient outcomes are the top priority. As healthcare expenditures increase, it’s vital that the government allocate funds towards proactive care, rather than reactive.
- Physician shortage. 700,000 people in British Columbia and nearly 13% of the population in the Atlantic provinces don’t have a family physician. In 2006, the Canadian age-adjusted physician-to-population ratio ranked 26th among 28 developed nations that maintain universal healthcare. This problem is further exacerbated by the fact that medical school enrolment has “remained flat over the past several years”.
- Technology adoption. At the latest Canadian Medical Association Health Summit, Dr. Philip Edgcumbe was quoted as saying that Canada is where “pilot projects come to die”. He added that the traditional fee-for-service payment model provides “little incentive to adopt innovative ideas to find efficiencies and improve healthcare quality.” In their 2018 white paper about technology adoption in Canada, the Information Technology Association of Canada reports that, of the 11 countries studied, Canada is “in the bottom two in terms of safety, timeliness of care and system efficiency.”
It’s clear that Canadian wait times must be addressed in order to improve patient outcomes and satisfaction. If Canadians are disincentivized to seek medical attention in healthcare facilities, it’s important to consider an alternative: providing medical care virtually. Telehealth, or the practice of delivering health-related services via telecommunications and virtual technology, is a booming digital health technology with the potential to solve excessive wait times. The most common types of delivery of care are secure video conferencing and instant messaging. Telehealth—often used interchangeably with telemedicine and virtual care—makes it easier for patients to connect with providers, and receive appropriate and timely care.
Telehealth gives healthcare professionals and organizations the capability to offer medical care to more patients with fewer logistical efforts. A Harvard Medical School study estimated that, on average, a typical visit to a doctor takes over two hours—of which only 20 minutes are spent face-to-face with the physician—and costs the patient $43 in lost time. Virtual care offers a convenient and accessible solution to patients. By using secure video conferencing, you can connect with your physician in the comfort of your home or office. Additionally, medical providers can utilize telehealth to support their patients in between visits.
Monitoring patients in between appointments and shortening wait times are crucial in treating acute conditions before they turn into chronic diseases (CDs). CDs are a heavy burden for the Canadian healthcare system. The Chronic Disease Prevention Alliance of Canada reports that CDs cost the Canadian economy “$190 billion annually, with $122 billion in indirect income and productivity losses, and $68 billion in direct healthcare costs.” As life expectancy increases, these diseases are expected to become more prevalent and lead to longer wait times, especially in hospitals. Proactive care through virtual visits can reduce unnecessary medical appointments and the economic burden of CDs.
Virtual care platforms also offer healthcare professionals and organizations practice management tools to further optimize their practices and reduce patient registration and discharge times. Efficient patient check-in and registration can streamline the process of visiting your physician. Pre-registration tools lead to patients spending more time with their physicians, instead of filling out paperwork. Having a centralized platform for booking, scheduling, and file sharing—among other features—is essential in reducing wait times for patients who require an in-person appointment with their doctor.
Canadian wait times are representative of a system that requires change. Some might even call for an overhaul. As with many nationalized systems, change of that grandeur can take decades. Unfortunately, the Canadian health system doesn’t have the luxury of time. Integrating telehealth—ideally with other digital health tools—into the nationalized system can reduce wait times, and, as a result, improve patient outcomes.
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