How to fix Canada’s broken health care system

So, once more, the Federal government will give more of our tax dollars to the provinces for health care but not as much as the provinces wanted. What else is new? This has been happening at regular intervals for the last several decades and the result has been a steady erosion of health care in Canada.

My first article on this subject was Prescription for improved medical care in Quebec and Canada. It argued for more private options and explained why that would be much better than our current system. This article will cover additional points. Those interested should read both articles.


In an earlier life, when I ran a survey software company, I used to advise clients that “What gets measured, gets done.” For example, if you want to measure the productivity of a carpenter, don’t look at the amount of sawdust that he produces but at how long it takes to build the framing for a house. In the former case a very poor carpenter might make many errors and cut twice as much wood as he should while producing twice the sawdust of one who makes no errors.

How do we pay doctors? We pay based on the number of patients she sees and the procedures performed. So a very poor doctor who prescribes the wrong medications, orders unnecessary tests and schedules many extra visits would get paid far more than a competent doctor who does everything well. In the former case, the patient suffers, ends up in the hospital, may need surgery and hopefully, eventually, might survive and even recover his former good health. The lucky patient with the good doctor avoids all that and remains in good health. So why are we paying the incompetent doctor so much more than the good doctor? The situation is just as absurd as paying a carpenter for producing sawdust.

In BC, they are offering full time family doctors the option of getting an annual salary of $385,000 rather than being paid on a fee per service basis. It would cut down the administrative burden on doctors and allow them to spend more time dealing with patients. It is a good idea.

Perhaps, even better, would be to pay doctors a salary to take care of a fixed number of patients. Then there would be an incentive to keep the patient healthy so there would be fewer visits. Of course, the pay would need to take into account the average age of the patients and doctors would not be allowed to take only healthy clients.

However, patient health is also related to the quality of the specialists who see them and the quality of the tests performed. This leads to having clinics/hospitals responsible for X number of potential patients. The funds received from the government would be based on several measurements including time to see a family physician, time to get a prescribed test, time until having a surgical or other procedure. Perhaps the best measure would be a sampling of the health of the patients in the cohort served by the clinic/hospital.

In this model the clinic/hospital could be private or public but the patients would pay nothing. Studies done in Europe show greater satisfaction with private providers. In addition, European countries have more doctors, beds and shorter wait times than in Canada. Some opposed to private options say the profit motive will lead to cutting corners but that is not what has been found in Europe and if the right metrics are used, the incentive to keep patients happy and healthy is what counts or else the clinic/hospital will not get patients or the government will remove them from the system.

Private options where the patient pays all or part of the cost are also possible. A small percentage of the population will use these options but those who do will reduce demand on the system paid for by the government.

Penny wise, pound foolish

Governments are always looking to save money. This is good in principle but can be disastrous if the full picture is not considered. In Quebec, some years ago the government offered generous incentives to get doctors to retire. Then when the baby boom generation got older and needed more health care, there were far too few medical professionals.

A more recent example is the decision to stop paying nurses with university degrees a premium. We have a huge shortage of nurses and now many more will go elsewhere after Quebec paid for their education.

How about the penalty new doctors pay if they do not work in the regions? That, too, drives doctors to other provinces, the US or Europe.

Bill 21 leads to health professionals leaving and discourages immigrants from coming. Bill 96 discourages English speaking immigrants from coming. If Quebecers in the regions understood this, would they still support these laws? I doubt it and when our health care system gets even worse, they will eventually wake up but how bad will the system get and how long will it take to repair it?

Why does the government make it so hard for medical professionals coming to Quebec to have their credentials recognized? We do not need more taxi/uber drivers, we need medical professionals.

A doctor gave me another example. He said the government funds X positions in a hospital department but in many cases young women starting a family would prefer to work part time and older doctors would also like to work less than full time as they transition into full retirement. Why can’t two doctors share a position? The government does not allow it so we have positions only partially filled instead.

Making the most of what we have

At every level we need to allow professionals to do more. Pharmacists should be able to write prescriptions in more situations than is now allowed. They are very well trained and in many cases know more about drug interactions/side effects than the doctor. This will save doctors’ time

Paramedics can do more in an emergency than they are currently permitted to do. This would save lives and reduce waits in emergency rooms.

Emergency room nurses should also have the authority to do some things that now first require a doctor’s OK.

Would doing the above lead to some mistakes? I am sure there would be some but in far more cases outcomes would be much better. In a war zone, medics do whatever is necessary. They do not have the luxury of getting everything checked by a supervisor/doctor/nurse. Our health system is rapidly descending into a war zone situation.

Some good news

Things have gotten so bad that recent surveys show most Canadians favor some types of private options. I think most people would be even more supportive if they realized that private options can be covered by Medicare and that even when they are not, they do not lead to stealing doctors from the public system. See my earlier article, Prescription for improved medical care in Quebec and Canada, for an explanation of why more private health care can lead to more doctors/nurses, not fewer.

Also, it seems that, almost daily, there is an opinion piece in one newspaper or another in favor of more privatization and this must influence public opinion and the politicians.

Finally, small steps are being taken. Quebec is allowing more private options and so is Ontario. However, we have a long way to go and the Federal law must be loosened to allow this trend to continue and expand.

A final request

As always, allow me to ask you to forward/share this article with those who might be interested and urge them to subscribe. My blog is free and will never have advertising but unless enough people get others to subscribe, it will be hard to get a critical mass. Hundreds of you are already on my mailing list but thousands would be much better.


  1. Thanks for the positive suggestions, they all make sense. Another way to control costs is to have people pay a minimum fee for services. If there were say $2.00 fee for filling a prescription, I would imagine people would be more careful about how many drugs they order, when not really required. BTW in addition to all the problems in health care in Canada, we have the Quebec insistence on French language proficiency. Israel recently allowed in over 900 foreign Physicians with no requirements of Hebrew knowledge, the idea being they will pick up Hebrew on the job. If only Quebec would be so open minded. All the best, Bernie Shuster.

  2. Thanks and I agree that Quebec’s Bill 96, Bill 21, and insistence on getting only French speaking immigrants all make it harder to get qualified health professionals. Quebec’s latest move to reduce paying for expensive private nurses will only drive more nurses out of the province.

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Picture of Dr. Bill Steinberg

Dr. Bill Steinberg

Dr. Steinberg has a BSc from McGill University, a PhD in Psychology from Northwestern University, and was a professor at Concordia University. He was Mayor of the Town of Hampstead for 16 years and led the demerger battle. He was was awarded the Queen Elizabeth Diamond Jubilee Medal and is currently President of the Cochlear Implant Recipients Association.

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