Governments spend hundreds of billions of taxpayer dollars every year on our country’s public health care system. Health spending in 2023 was expected to reach $344 billion, about $8,740 per Canadian. That's a lot of money for a health system that is failing to meet the needs of so many. As we approach the end of 2024 and many Canadians consider New Year’s resolutions for their personal or professional lives, perhaps it’s time we consider resolutions for our ailing health system.
For generations, our health system was a source of pride. Sadly, we haven’t been able to say this for a while. Physicians, other health care workers and patients alike have watched the system slowly deteriorate over the past 20 years.
Successive governments at all levels and of all political stripes have made commitments to improve health care with mixed results.
While these issues took decades to develop, the pandemic pushed the health system past its breaking point to where we find ourselves today: 6.5 million individuals lack a primary care provider, emergency departments nationwide close intermittently due to staff shortages, and wait times for surgeries and diagnostic tests are still unacceptably long.
Canadians are rightfully worried and losing hope. Polling across the country consistently illustrates that health care remains a top priority among voters, but a CMA survey from summer 2023 showed that only 26% of Canadians considered the health care system to be in excellent or very good condition. Just a quarter of those surveyed were optimistic that anything would improve over the next couple of years.
However, I’m encouraged to see some progress in health-care reform that will help improve access to care: provinces are exploring team-based care models and efforts are being made to entice physicians to practise in rural settings; several provinces, including British Columbia, Manitoba, and Nova Scotia improved their payment models for family medicine; the Atlantic Physician Registry has enabled greater mobility of the physician workforce, demonstrating a step forward on streamlining multi-jurisdictional licensure; several provinces are adopting legislation to eliminate or reduce sick notes; and millions of dollars were invested into streamlining the recognition and integration of internationally trained physicians.
Earlier this year, the federal government signed agreements with all provinces and territories for the most significant health care investment in more than two decades. Importantly, it included accountability measures requiring provinces and territories to report progress on improving access to family health services, mental health and substance use treatment; easing treatment backlogs; expanding workforce capacity; and modernizing the health system, including advancing digital health.
Since then, a Canadian Medical Association (CMA) analysis concluded that some provinces and territories aren’t meeting the critical targets outlined in the agreements and some key information is missing altogether. For example, to date, no jurisdiction is meeting its targets to improve access to primary care. Likewise, none of the provinces and territories have set targets to eliminate or even track emergency department closures, despite Canadians nationwide experiencing three summers in a row where this previously unheard-of situation has become a common occurrence.
More needs to be done. These accountability measures announced last year are an excellent first step, but governments must go further. Canadians deserve information on key indicators in the health system, the number of hospital emergency department closures per year, and the percentage of health workers reporting burnout.
These performance metrics would allow Canadians to monitor how their health system is functioning, what the pain points are and whether their government’s efforts are succeeding or failing.
Canada also needs a chief health accountability officer mandated to monitor and report publicly the implementation of intergovernmental health agreements to ensure all parties are delivering on their commitments for Canadians. An accountability mechanism would ensure that health dollars are effectively spent and that governments achieve the necessary outcomes to ensure Canadians are getting the care that they deserve. We hope to see a commitment from governments to strengthen and renew current bilateral agreements, ensuring Canadians receive the full value for their investments in health care.
As we end the year and reflect on the harsh realities confronting our health system, I still find myself feeling optimistic. We have seen important steps toward improvements, and it is my sincere hope that 2025 brings about far more transparency, accountability, and most importantly accessibility to our health system. Canadians deserve it.
Dr. Joss Reimer is a public health physician in Winnipeg and the president of the Canadian Medical Association.
This commentary was first published by The Hill Times on Dec. 29, 2024.