We have already become aware of the impact of the coronavirus on minority and disadvantaged communities. We are now attuned to the dismal state of elder care, particularly in the two largest provinces in Canada. We have a sense of the deep disarray many public health units are in, and the fragmentation of our public health response. We felt the absence of a national procurement strategy for the supply of sufficient personal protective equipment to the front lines.
But there is one gaping need that has been exposed during this first phase of the pandemic that has not caught the public’s attention, and that is the sustainability of our health-care system. Unless policy is crafted carefully over the next few months and years, the nature of our universal health-care system will be one of the victims of the coronavirus.
When we think of health-care costs, many Canadians, abetted by politicians, think of doctors’ billings, nurse salaries and drug costs. While those are important drivers of cost and performance of our health-care system, one other item rarely shows up on the spectrum of costs: capital investment.
Capital investment is needed in three major areas: infrastructure, technology, and training and human resources.
Many hospitals and institutions are housed in buildings that date from the middle of the last century and require significant infrastructure support to bring the buildings up to the necessary standards of the third decade of the 21st century. The result is inadequate facilities that sometimes hinder best practices in infection control and patient-centred care, but also incur exorbitant costs associated with any renovations due to the age of the buildings.
The pandemic has exposed the dearth of investment in technology at many levels. Within hospitals, patients must still be brought to areas where an additional level of care is available rather than have the technology and the appropriate level of care delivered in their location. Surgical patients must be moved from surgical wards to the intensive care unit to receive a particular kind of monitoring or certain drugs or to have eyes on the patient. Yet sophisticated remote monitoring exists that would allow patients to receive the appropriate level of care in many instances in the environment where caregivers know them best.
This applies even more urgently to smaller community hospitals, which often must transfer patients to larger centres simply for higher levels of monitoring. In contrast, in the United States, remote or virtual ICU technology is part of the health-care landscape with larger centres providing remote monitoring and advice for patients in smaller hospitals without having the added burden and cost of transfer.
Finally, the pace of new equipment and procedures has accelerated in the past two decades. Training nurses, physicians and other health-care workers to become competent with these procedures and equipment requires ongoing training. Many hospitals have had to significantly limit their training budget as their operation funds have been clawed back by successive government cuts.
As the acute phase of the coronavirus recedes, and hopefully the epidemic is brought under a measure of control with the arrival of a vaccine, we will be left with the economic devastation that has resulted in terms of not only a changed economy, but also the added debt burden.
Before the coronavirus struck, Canadian provinces had a debt burden ranging from 44 per cent (Saskatchewan) to 75 per cent (Ontario) of GDP. These figures do not include the federal debt. While the cost of borrowing will likely remain low for some time, the impact on government spending will be inescapable.
Historically, capital spending on health care has gone through wild swings that outlast the election cycle. Without innovative solutions, it is likely this pattern will continue, and be exacerbated by the current economic outlook.
The situation is not entirely bleak, however. There are a range of possible solutions that would both protect the public coffers as well as provide the necessary investment for our health-care system to not only survive but also be ready for the next major crisis.
Investments in technology, including remote monitoring, can result in immediate cost savings and may be possible to implement through public-private partnerships. Investments in infrastructure can result in avoidance of billions of dollars in maintenance. For example, a 2015 study estimated deferred maintenance costs accumulated by Canadian hospitals to be between $15 billion and $28 billion.
We will face difficult economic choices in the near future. But if we are to preserve a universal health-care system that lessens rather than exacerbates structural inequities we must invest in innovative ways of rebuilding the system. To carry on as before will result in the certain dismantling of our health care, and by proxy, possibly the last remaining equalizer in our society.
Wael Haddara is chief of critical care at London Health Sciences Centre
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