Canadian Health System Crisis: How Commercial Players Can Make An Impact

Creating system capacity. Improving access to care. Enhancing the patient and family experience. Empowering health service providers. Improving quality and outcomes. Enabling innovation through technology. Movement toward achieving these objectives will help address the national health system crisis in Canada. How can we make any of this happen with the many obstacles we face, that are now even more exacerbated by widespread fatigue as a result of the pandemic?

The answer is, we need all of the help we can get, and that includes the private sector. Canada has long had private players - commercial, profit making enterprises - as core to our health system. Physicians, laboratories, homecare and residential care are a few examples of where the private sector has contributed. However, most commercial players are deeply constrained, not by the Canada Health Act, but rather by the complexity of health system governance and outdated, narrow budget structures.

Our country has many strong, commercial health leaders who want to innovate in health, whose missions are to find solutions to address long standing problems. But their efforts are constrained by budgets and processes that are literally fragmented like an infinity mirror. For example, providing care at home rather than in a hospital is the preferred environment for patients, families and providers (assuming acute care services are not required). It is also more cost effective, frees up hospital capacity, and allows for greater access to other community resources. There is excellent technology available for remote patient monitoring, access to virtual care, and integration with primary care systems and pharmacies. The business case for investment is clear. But who is responsible for payment and oversight? While the hospital clearly benefits, their budgets are not designed to pay for care outside the hospital walls.  

The commercial barriers in Canadian healthcare (in part due to the challenges I co-wrote in 2019 related to procurement) have resulted in many failed ventures, as well as abrupt industry and jurisdictional pivots. These delays have undoubtedly resulted in missed opportunities to improve patient care and health outcomes.

However, we demonstrated through the COVID pandemic that we are very capable of reforming procurement and other decision making processes.  To tackle the urgent need for transformation, we must urgently consider how to restructure our approach to funding in order to incent and encourage commercial innovation in the Canadian health system. For example, centralised budgets for transformative projects should be allocated nationally, and rolled out regionally. The risk tolerance in the private sector is much higher, and this culture is essential. To accelerate impact, Canadian government(s) should contract the risk of implementation onto commercial enterprise, and establish a compensation structure that reflects that risk and is centred around driving adoption and outcomes.

Many Canadians are not receiving the care they need. They are avoiding (or can’t access) primary care because of wait times, complexity and frustration. The current system lacks a consumer focused approach, where in most cases we are not able book appointments online or receive convenient, virtual follow-up care. Industry leaders have long said that we have a “sick care” system in Canada - one that is setup to care for the acutely ill.  Without taking decisive steps to expand the capacity of our health care system, we will see worse health outcomes and more pressure, especially as our population ages.

We need to keep our Canadian innovators engaged and committed to healthcare while simultaneously building a system that sets them up to succeed, if we have any chance of moving the dial in our lifetime. The natural tendency in the health sector is to wait for things to go back to normal, but more waiting will continue to put the system and health care workers closer to the brink. The bold move is the safe move and it's what is needed to climb our way out of the healthcare crisis we are in today.