A Call for Global Ambition in Canadian Health care

Our single-payer system could benefit from some market forces

Posted October 18, 2019By Shaun Francis is the chair and CEO of Medcan

Failing to expand on health care in this years federal election

Health care has barely been mentioned in the federal election campaign. It wasn’t among the official five topics mentioned during the English leaders’ debate and the leaders who did mention it raised the topic only tangentially.  That’s disappointing. We have an enormous opportunity to transform this sector from an economic drain to a source of profits—if only we could get past an ideological hang-up. From BC to Newfoundland, our hospitals and clinics feature some remarkable talent. We have some of the world’s best physicians and surgeons. I know this firsthand, because I work alongside many of them at Medcan. Yet these bright stars are shackled by a system that tamps down ambition and discourages innovation. The result is health care that lags in quality and responsiveness compared to countries around the world with similar systems.

The Fraser Institute has attempted to raise awareness about how poorly Canada’s health care  is managed. Age-adjusted analysis in a report released earlier this month reveals that among the 28 OECD countries with universal health care, Canada ranks 2^nd highest for health care expenditure as a percentage of GDP. In fact, we devote more than a tenth of our overall output to health care—more than the UK, Sweden, New Zealand and Australia. “Clearly, these indicators suggest that Canada spends more on health care than the majority of high-income OECD countries with universal health-care systems,” says the report. Yet few of us ever consider the cost-implications of health and wellness decisions, because there’s no correlation between what we use, and what we pay.

The benefit of entrepreneurial thinking

So how do we improve things? Medical tourism represents a mechanism to spur investment in a system the government regards purely as a cost. Size of global market is difficult to gauge with precision, but industry advocate Patients Beyond Borders estimates it at north of $65 billion US annually. The group believes more than 20 million people travel for medical reasons every year, including 1.9 million Americans. Top specialties for medical tourists include joint replacements, gastric bypass procedures and cosmetic surgery.

Given a similar opportunity to reach global markets, other industries would leap at the opportunity. Our educational system at all levels happily accepts the funds of foreign students who travel from overseas to go to such schools as McGill, the University of Toronto and UBC. Tourism operators from the Rockies to the Maritimes seek out dollars spent by international travelers.

The Canadian health care system could benefit from some similarly entrepreneurial thinking. While hospitals like Sunnybrook and University Health Network have dabbled in catering to international patients, the current posture is to seek out reasons to turn them away. We require medical tourists to jump through numerous hoops. They’re required to prove the procedures are medically necessary, and that they aren’t able to obtain the services in their home countries. The red tape limits demand. We make things difficult for international patients because some folks don’t really want them coming here—in case they contribute to already long wait times for some procedures. But my own experience with the combination of free enterprise and health care suggests pursuing the global market would end up improving our system, eventually tamping down wait times.

Encouraging change in health care

Encouraging hospitals to charge international patients for in-demand medical procedures would spur investment to create greater capacity and attract talent. The profits could be rolled back into the system to shorten the very wait times causing people so much concern. Whether you’re talking angioplasties or hip replacements, greater demand and the potential for profits could trigger greater specialization, expanding supply and boosting surgical quality and capital equipment investments.

Pursuing the market for international patients recently led the Mayo Clinic and numerous competitors to expand to the UK. Canada’s reluctance to pursue medical tourism represents a missed opportunity to improve our system—or at least, to catch up with international competitors. It’s time to open things up to a little international ambition. Likewise, it’s time to drop our fears around health care in Canada.