Change is Hard and it is not Very Easy: Time to Move from 14 Healthcare Systems in Canada to Something More Effective

A Commentary by R. Douglas Wilson, President

(Note: this is a summary of Dr. Wilson’s presentation at West/Central CME on March 16)

We can no longer be silent and not advocate for what we feel is important or is being ignored by the provincial health systems and politicians.

It has been 60 years[i] since a provincial healthcare system was thought to be a good idea followed by 1984[ii] when the first Prime Minister Trudeau made it constitutional. But the truth is, in hindsight, it was a significant healthcare management opportunity missed as a national plan was needed.

The SOGC, through Dr Nick Leyland, Dr Diane Francoeur, and myself, have attempted to grab the media’s attention with some ‘big C’ innovative as the thought and the talk for an ultimate federal-provincial healthcare showdown was looming. We tried the Globe and Mail, The National Post, and the Toronto Star but it seems new ideas are hard to sell in healthcare. SOGC has put out the commentary of our thoughts as a PODCAST in March 2023.

In addition, the SOGC has contributed nationally with two health policy publications in the Canadian Health Policy Journal:

• https://doi.org/10.54194/LHSA7302;
• https://doi.org/10.54194/GTEX1486].

The theme of the recent ’13 premiers and a prime minister’ chat was ‘how to get a share of the $196 billion with no strings attached’. The present rate of federal support for provincial healthcare was 22% but the premiers wanted 35% and they left the meeting very disappointed.

The inability of each Provincial Healthcare System to be accountable for their quality, access, and outcome is reflected in the fact they do not want any measures to show or document how poorly they manage and spent the taxpayer’s dollars.

So back to the Premier’s chat, the Federal Government wants to have all the long-term funding agreements completed before this spring’s 2023 federal budget. A key issue will be the conditions on the bilateral funding arrangements as a part of these agreements, has the provincial and territorial governments being asked to develop action plans that will outline ‘how funds will be spent and how progress will be measured’. This type of expectation or oversight requires that the provinces become more accountable and deliver the quality and outcome expected from the funding rather than enforcement from the federal government with no data to know if it has been done or not.

What business could use this management process and survive unless you are just able to keep everyone in the dark, the patient, the healthcare provider, and the funder (federal and provincial citizen taxpayers via their provincial politician’s whim)?

Gynecologic and Obstetric Healthcare in Canada Requires National Leadership as the Siloed Provincial Efforts are Failing.

Why is a national leadership approach required?

In 2021, Canada’s provincial-national health spending was greater than $300 billion ($ CAN). The lack of measurable ‘knowledge translation’ success over the last 20 years has been identified as a barrier to creating new health policy reform. The efforts for clinical quality improvement might better be focused on increasing the healthcare systems’ resilience and devising better models of care.

The provincial healthcare system needs and services are: politically driven and focused for clinical service; lacking a validated health care priority process with outcome audits; showing little or no provincial accountability following federal transfer funding directed at specific service gaps; limited in ‘real’ interprovincial collaboration for human resources and service management. The recent pandemic and influenza prevalence continues to show the inability of the 14 healthcare systems to be effective.

Who is providing national leadership?

The Society of Obstetricians and Gynecologists of Canada (SOGC) play a national leadership role with peer-reviewed evidenced-based clinical guidelines and directed educational activities for undergraduate, postgraduate, general and specialty providers in obstetrics and gynecology. Provincial and national leadership opportunities within the SOGC are created through networking, working groups and committees. Collaborative dialogue with affiliate associations (CMPA; HIROC; pediatric, anesthesia and surgical academic societies) and urban and rural providers in maternity / gynecological care. 

Final commentary on possible high-level national and provincial considerations

Change will require an effective healthcare advocacy process with: anappropriately directed action for a prioritized clinical concern ; professional interaction with integrity; a clear understanding for the conflicts of interest; a well-defined strategy and communication process; an informed approach based on the best evidence available; a consideration for the process with multiple options and solutions; one and all must be open and respectful to other opinions and the political barriers; the proposal needs to be understandable; measurable, accountable; but most importantly there must be a consideration for persuasion rather than threat.

The four considerations, below, have significant complexity, financial, and implementation issues: 

Federal / National Initiatives

• Crown Corporation for a National Healthcare Management: time to reconsider National or Regional Heath Care Service Models (federally funded; 3 to 5-year national process) as Canada has only 36 million people, not that many, but spread across a broad geography.
• National facilitation and Provincial joint funding for increased post-secondary healthcare human resource education, rural healthcare planning, professional licensure, national medical drug plan, and public health / chronic and infectious disease management.
• Accountability by provincial administrative recipients of federal healthcare transfer payments including the timely reporting of the provincial project’s impact and outcome.

National-Provincial Initiatives

• National-Provincial collaboration for regional / geographic merger to allow for healthcare efficacy and cost savings with an improved opportunity for access, quality, and patient safety outcomes: North-West Region: BC, Alberta, Saskatchewan, Manitoba, Yukon, NWT, Nunavut (population 12 million); Ontario Region: (population 14 million); Eastern Region: Quebec, NB, PEI, NS, NFLD-L (population 12 million)
• Inter-provincial agreements would be required to decrease the ‘large-scale’ multiple provincial redundancies in administrative, financial, human resource, and clinical service models to create a single regional healthcare system.

Ethically Directed Healthcare Prioritization

Ethical-weighted clinical service grouping will provide the preventive opportunities for decreasing morbidity and mortality using ‘impact of care’ and ‘effectiveness’ measurements to help direct appropriate health care funding and service delivery. The focusing of healthcare funding on maternity, newborn, pediatric care, primary and secondary disease prevention, and chronic disease management is directed toward creating population health. This change would decrease the clinical priority for the ‘present’ high priority fatal surgical-medical services.

Other Human Resource Considerations

The provincial healthcare administrative systems have overlooked or blocked the potential human resource use of physician assistant (PA), advanced practice nursing, or other foreign-trained healthcare support resources. Safe and quality care must be considered along with the fiscal considerations.

Please see the Commentary article published in the JOGC March 2023 but this DEPHI has had some information added.
Thank you but remember a quote from Winston Churchill ‘Success is not final, failure is not fatal; it is the courage to continue that counts’.

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[i]  Recommendations from the Royal Commission on Health Services (1961-1964), also known as “Hall Commission”: URL

[ii] Adoption of the Canadian Health Act: URL