The Canadian Institute for Health Information (CIHI) has released a new report, which lays out the key areas that governments need to focus on in order to improve struggling health-care systems.
The report is the result of an agreement between the federal, provincial and territorial governments to investigate where they can improve health care can be improved in Canada.
Governments, with the exception of Quebec, agreed to work with CIHI to collect and share their health-care data. CIHI plans to share the results publicly every year, making this report the first of an annual series.
This first report, which focuses on giving a snapshot of the current landscape of Canadian health care, found that surgeries dropped by 13 per cent during the pandemic compared to pre-pandemic levels and that Canada is underutilizing the potential of electronic tools, with fewer than 40 per cent of Canadians reporting that they’ve accessed their health information online before.
“We know that there are gaps in Canada’s health-care systems, but there are also improvements happening every day,” Kathleen Morris, vice-president of research and analysis at CIHI, said in a press release.
“This report provides a look at challenges that exist around the country. Over the coming years, transparent public reporting using comparable data from modernized health systems will be an important aspect of the improvement effort. It’s an important step in working with all levels of government as they work to improve health services for Canadians.”
Although Canada’s universal health-care system has long been a source of national pride, the COVID-19 pandemic placed huge strain on the nation’s health-care services, causing issues that we are still grappling with today. Massive worker burnout has caused many to leave the profession, others are struggling without proper mental health supports, surgery delays are exacerbating backlogs and hospitals are struggling with being over capacity.
It’s an issue that Canadians are well aware of, with many reporting in various surveys that they have had more trouble accessing care in recent years.
The Angus Reid Foundation reported in an August 2022 survey that around 40 per cent of Canadian adults found it difficult or impossible to access at least one of five key health services – emergency care, non-emergency care, surgeries, tests and specialist appointments – within the past six months.
In February 2023, an Ipsos poll found that the percentage of Canadians reporting their health care as “good” fell since the start of the pandemic. In 2020, 72 per cent of Canadians surveyed rated the quality of their health care as good, compared to just 60 per cent in 2023.
THE CURRENT OUTLOOK FOR PRIMARY CARE
Right now, around 88 per cent of Canadians report having a regular health provider, according to CIHI. This data comes from surveys run between 2019 and 2021.
However, this varies widely across the country. The province or territory with the lowest percentage was Nunavut, where just 24 per cent of respondents said they had a regular health provider. The highest percentage was Ontario and New Brunswick, where 90 per cent of respondents said they had a regular provider. The lowest percentages were in Prince Edward Island and British Columbia at 81 and 83 per cent respectively.
Age also played a factor. Young adults aged 18 to 34 were the least likely to have a regular health-care provider compared to other age groups, the CIHI report found. Seniors were the most likely to have a regular doctor.
“My adult child lost his pediatrician once he turned 18 and must find a walk-in clinic any time he needs care,” Amy Ma, a patient and public adviser for Choosing Wisely Canada, said in the report. “My family doctor is not accepting new patients. I think having multiple clinics in the same neighbourhood work together to provide after-hours and weekend care for patients could help address some of the problems. Being seen on the weekend means people won’t miss work and the kids won’t miss school.”
Many family doctors have left their practices since the start of the pandemic, leaving some Canadians struggling to find providers, especially in rural and remote areas. According to CIHI, the Atlantic provinces had the highest percentage of respondents who said that providers in their area were not taking new patients.
The report noted that more data needs to be collected on how access to primary care varies depending on where people live, as well as their income level, language, race and gender, in order to find out who is lacking access.
The authors also suggested that lessons about virtual care learned during the pandemic should not replace in-person care but be used to help improve access to care and reduce costs.
“One option is for people to have access to nurses, paramedics, EMTs [emergency medical technicians] or others to supplement in-person services. People could receive virtual care from a doctor or nurse practitioner with on-site staff who could see them,” Dr. Onil Bhattacharyya, Frigon Blau Chair in Family Medicine Research at the Women’s College Hospital in Ontario, suggested in the report.
“The idea is to triage patients — figure out who wants a family doctor, who has an urgent need and start creating an attachment program for the people who need a doctor most.”
SURGICAL BACKLOGS AND WORKER FATIGUE
In the first two and a half years of the pandemic, there were around 743,000 fewer surgeries performed in Canada, a decrease of 13 per cent compared to before the pandemic.
In order to reduce surgical backlogs, hospitals will need to increase their rate of surgeries above pre-pandemic levels, something which has been achieved in several regions of Canada, with increases between one and nine per cent from March 2021 to June 2022.
The drop in surgeries performed during the pandemic was greatest in Manitoba and Newfoundland and Labrador, which saw 18 and 21 per cent drops respectively compared to pre-pandemic levels. The only region to see no drop in surgeries – apart from Nunavut and Quebec, for which data was not available – was Prince Edward Island, according to the report. The smallest drop in surgeries compared to pre-pandemic levels was British Columbia, with a seven per cent drop. These numbers represent the percentage change in the number of surgeries done monthly between March 2020 and September 2022, compared with those done in 2019.
But while surgeries went down during the pandemic, overtime went up, with overtime hours for staff increasing by 15 per cent in 2020-21 compared to the previous year.
Around 18 million overtime hours were worked in that time period in Canada’s hospitals, representing the work of around 9,000 full-time jobs – a stark reminder of how woefully understaffed and overworked our health-care system is.
While the number of nurses is still increasing in most provinces and territories, the number has decreased in some settings, such as long-term care, which has seen a two per cent decrease in nurses between 2020 and 2021.
“One of the huge issues we have in this country [is that] there is no human health resource plan that’s pan-Canadian,” Dr. Katharine Smart, a pediatrician in Yukon and past president of the Canadian Medical Association, said in the report. “We don’t have the data so we can look [at whether] we need this many nurse practitioners, we need this many nurses, social workers, et cetera, to really understand how to deliver integrated team-based care across the country in a sustainable way.”
One issue with mental health services is that many are not tailored for youth, the report stated, despite the fact that 70 per cent of people living with a mental illness experience symptoms before the age of 18.
Around 1.2 million children and youth in Canada are estimated to be affected with a mental health disorder, and face the additional challenge of finding resources and then transitioning to adult resources when they no longer qualify for youth-centred ones.
Canada has 47 active integrated youth services sites currently, with 25 under development. Nearly half of these are in Ontario, which has 22 active and eight in development. Nunavut, Yukon, P.E.I., Nova Scotia and New Brunswick have zero active integrated youth sites, but New Brunswick and Nova Scotia have three and one in progress respectively.
This doesn’t mean there are no mental health supports in these provinces currently, but that there were no provincial- or territorial-funded integrated youth service sites when this report was prepared.
In 2018, more than a quarter of Canadians who had a diagnosed mood or anxiety disorder said they had at least some unmet mental health care needs in the past year. In the fall of 2020, around one-fifth of Canadians 12 and older reported needing mental health care in the last year, and nearly half of this group said these needs were unmet or only partially met.
The report found that in 2020, half of Canadians were able to access counselling services in their community within a month – but one in ten had to wait around four months for access.
“Accessing mental health care takes a very long time, even when a youth is in crisis for months. About five months prior to being hospitalized the first time, my family doctor advised my parents to take me to hospital due to being in a mental health crisis,” a 19-year-old patient identified as Hannah stated in the report. “Even when a youth goes to the emergency department suicidal, you get sent back home without care and put on a wait list.”
BETTER ELECTRONIC DATA KEEPING
Over the last few decades, many services such as banking have become more accessible through online options – but in the world of health care, the digital realm is underutilized, the report found.
Less than 40 per cent of Canadians, not including those in Quebec, have been able to access their health information online, the report stated. Another survey found that less than 20 per cent of Canadian doctors sent patient information electronically to other doctors involved in a patient’s care.
“I was on call last week and I’m looking at laboratory reports, at X-rays, I’m talking to a specialist. I’m talking to the family or the patient. I’m gathering all this information and then crafting an approach to care,” Dr. Ewan Affleck, a physician in Northwest Territories and senior medical adviser for health informatics at the College of Physicians and Surgeons of Alberta, said in the report.
“If I’m missing some of that information, or it is inaccessible, or I do not know it exists because it’s on a different platform, the likelihood of my making an error increases.”
Not leveraging the numerous electronic tools available is slowing down the delivery of health care, the report stated.
More than 80 per cent of those who were able to view their health information online reported feeling better informed about their health and better able to manage it.
One other aspect that future reports will touch on is the status of health care for Indigenous people in Canada. The report noted that racism in health systems is a serious issue and that CIHI will work with Indigenous leaders and experts to collect data on health in Indigenous communities in order to understand the issues they are facing.