Canada’s health care system is not providing full value for public money spent and needs to be urgently “rewired”

Canada urgently needs to “rewire” its health care system because Canadians aren’t getting full value from the $400 billion – or 12.7 percent of GDP – spent annually on health care, say health-tech and health care leaders.

Canada needs to treat its health care system as an industrial strategy like national defence and security, ensure Canadians have control of their health data, and use that data to support and grow innovative health-tech companies, they said during a Council of Canadian Innovators (CCI) webinar.

“Canada's health care costs are growing faster than the economy, which is usually not a recipe for financial stability or sustainability,” said Laurent Carbonneau (photo at right), CCI’s vice-president of policy and advocacy. “This system is going to reach a bit of a critical breaking point unless something changes.”

“Better public buying can make a big difference in how we provide care,” he said. For CCI, “the heart of the matter is if we're not looking at integrating buying from domestic innovators as a priority, we're missing the mark.”

Especially in the health care sector, utilizing robust, domain-specific data is crucial, coupled with open standards and interoperability mandates, to enable more competition, technology adoption and innovation in the marketplace, he noted.

“We have firms that are ready to scale and contribute to improving the quality of care that Canadians get, but we need to address the policy blockers that are currently keeping them from doing so,” Carbonneau said.

“It is pretty clear on its face that we do not have a value-for-money approach to how we are doing all of our health care, let alone just procurement,” said Dr. Andrew Bond (photo at right), senior vice-president and chief medical officer at Windsor, Ont.-based Greenshield, a not-for-profit focused on integrated health insurance coverage and care for groups, individuals and students.

The $400-billion a year Canada spends on health care amounts to about 43 percent on average for provincial budgets – or about $9,600 per Canadian, Bond said. “We are tapped out in terms of our spending.”

Australia or the Netherlands spend the same amount per capita on health care, “and do far, far better in terms of their impact and their equity of service,” he said.

Canada’s 12.7 percent of GDP spent on health care compares with nine percent on average for the Organisation for Economic Development and Co-operation’s (OECD) 38 countries, he noted.

Yet Canada has only 26 beds in hospitals per 10,000 people compared with 43 hospital beds per 10,000 people on average for OECD countries, he pointed out.

Canada also has 27 physicians per capita versus 38 physicians per capita for OECD countries.  

And 6.5 million Canadians are currently without access to primary care.

Reorient health care spending around value and patient outcomes

Twenty percent of Canadians suffer from depression or anxiety, Bond noted. That costs Canada about $16.6 billion annually in absenteeism costs, he said.

Depression and anxiety amount to one-third of all short-term disability, but 70 percent of the cost of all disabilities in terms of productivity and performance in industry, he added. “It's a great driver and drag right now, but an opportunity for improvement.”

Bond pointed to the Ontario Structured Psychotherapy Program at Ontario Health’s Mental Health and Addictions Centre. Two million Ontarians need access to good, basic, digitally accessible mental health care for anxiety and depression, he said.

Yet the pilot program “is ring-fenced, so it can have no more than 20,000 – out of the 2 million Ontarians who have needs –  who are allowed to have access,” he added. “Unfortunately, only about 5,000 actually have access to the digital cognitive behavioral therapy programs that we have.”

The Ontario pilot could be scaled up to the entire province tomorrow, Bond said. “The only limitation on the ability to do this for us or any others is the “Yes” and the political courage and the willingness to ensure that those 2 million Ontarians, for example, or the 8 million across the country, have access to this.”

The pilot is funded by government, “but is kept at a period of stasis that we could go to scale very quickly with the support – and it really just needs the support to be able to do that.”

Bond cited another example: 33 percent of Canadians are currently overweight or obese, which costs Canada $21 billion a year to the economy on productivity loss.

At the same time, GLP-1 medications, used to manage obesity and Type 2 diabetes, come off patent in Canada this year, he noted.

“Except we have not set ourselves up to be able to support Canadian pharmacy and pharmaceutical production, to be able to be a global leader in generic GLP-1 medications. This is something that is catastrophically impairing our healthcare systems.”

Twenty-five percent of Canadians will have a serious chronic disease by 2040 that requires ongoing hospital engagement, but Canada’s health care system doesn’t have the ability to support those patients, Bond said.

“We an opportunity to do that, but that requires Health Canada and [pharmaceutical] production support, and more of a major project industrial strategy to be able to support the production of generic Canadian based GLP-1 medications.”

Value based-procurement means looking at what's the problem we're trying to solve and how badly do we need to solve it, Bond said.

Health care, he said, has a quintuple bottom line: population health, economic efficiency, provider experience, patient experience, and equity. “All five of those things have to happen to be able to actually meet all the needs, and we have an opportunity to reorient around value.”

More support needed for innovative Canadian health tech companies

Canada’s innovative health-tech companies are being undercut by foreign entities and lack of government support at home, said Mike Cook (photo at right), CEO and co-founder of Toronto-based INDENTOS Inc., a supplier of digital trust technology and services.

The country “is largely over a barrel with significant amounts of our data in our technology in the hands of foreign nationals,” he said.

“Then all of a sudden we just see foreign states making new decisions, new policy, new legislation that gives them far-reaching capabilities into other states . . .,” he added.

Recent conversations at the Digital Governance Council about losing control of domestic data and the subsequent risks to national sovereignty “were scary enough to keep you up at night,” Cook said.

He said as the son of aging parents and as a parent of a high-needs child, “I see every day we're arriving to appointments before our data gets there. We're duplicating our tests. I see the doctors are just like scrambling to do the administrative work associated with care and not providing enough care.”

Canadians need to be empowered when it comes to their health data, Cook said. “Our data is already there and we should be able to apply it to the best interests for us and our family and loved ones.”

In a pilot that IDENTOS and other partners did with the BC Children’s Hospital, 94 percent of people opted in to donate their data to health care research, he noted.

Canada needs to act on all of the bottom lines associated with creating the market for data-driven digital health technologies and supporting Canadians, while at the same time driving efficiency to address the unsustainable costs of their health care sectors, Cook said.

There is a significant number of technology-leading Canadian innovators working on all the health care system’s problem areas, but “they're not getting the light of day,” he said.

“What's happening is these guys are getting piloted to death. They're dying on the vine. They're getting sold for pieces to multinational companies and all of this wonderful IP that, at the beginning honestly was from the hearts of Canadians to try to solve the problem for other Canadians and their families, is going out the door to a foreign national and being sold back to us.”  

Government needs to move from recognizing that buying Canadian really matters to providing more support to innovative health-tech companies, Cook said.

The federal government’s Bill S-5, introduced in February this year, “does a fantastic job of starting to level the playing field for Canadians,” he said.

The proposed Connected Care for Canadians Act aims to standardize, secure and improve the exchange of digital health information across Canada. It mandates interoperability for health IT vendors, prohibits data blocking, and enables seamless patient information sharing between systems to improve care coordination. 

Utilizing data and digital technologies can improve research and save patients’ lives

Any strategic procurement first and foremost needs to make sure that patient outcomes are the most critical area, and that patients, health care providers and workers are taken care of, said Shane Sabatino (photo at right), chief people officer at Vancouver-based digital health firm WELL HEALTH Technologies Corp.

WELL Health, which provides a suite of digital, telehealth and electronic medical record services to modernize clinicians’ workspaces, operates 252 primary and specialized care clinics across Canada, with 4.3 million patient visits per year.

Using Canadian health data and innovative domestic companies’ technologies can both improve research and save patients’ lives, Sabatino said. “But we have to get there fast. We not making large progress on that.”

“I think this is where we're going to need government and private sector and all of us to agree to standards [and] come together urgently, quickly,” he added.

“We could change health care, we could help Canadians, we could help the world, if we stop trying to worry about every single aspect of data and trying to make we can make it safe. We absolutely can make it safe,” Sabatino said.

Canada has a shortage of family physicians and doctor-owned clinics’ margins are so small that many doctors are getting out of running clinics because it’s a losing business, he noted.

“So at the end of the day, we have to make our clinics extremely efficient [with] online booking, making sure that we are using ethical, confidential consent-based AI scribes,” said. “Because that is truly, in my opinion, the only way we're going to deal with the doctor shortage.”

Doctors are burdened by note-taking forms, employee notes, all of the stuff that is not what they should be doing,” he said. “We could get 10,000 to 20,000 doctors’ time back into the system [with AI scribes].”

Yet Canada is allowing foreign companies with competing – but not better than Canadian – AI scribe technologies to come to the country “and jump into our ecosystem, and then overnight we are going to have more international AI scribes, clinical-decision support – all of those new companies are now embedded.”

“I think it's critical that we start to look at how do we build, buy, scale [and] support Canadian organizations, Sabatino said.

Bond said he worries about the scale of technology supply-demand mismatch between health care providers and actual projections for chronic diseases.

For example, projected hospitalization and aging in Canada show that relative to the country’s current health care fiscal space, increasing provider efficiency “is not going to get us where we [need to go],” he said.

What is required is “actually reconfiguring and rewiring our health care system, figuring out not just the team-based care of what can go to this provider versus that one, but which things are handled with technology, sometimes [as] complements, sometimes alone,” Bond said.

Twenty percent of Canada’s hospital beds are taken up by people who are ready to go home, he noted. “We are not using our resources appropriately.”

“That means we need to bring new tools, which we do have now, to be able to help and support and integrate into the operations of our system.”

People want their health information “in the palms of their hands, and frankly we cannot learn as a health care system if we don't have the data integrated in ‘lakes’ that are usable to learn together,” Bond said.

Recent polls indicate that over 75 percent of Canadians are not only ready for, but calling for transformative change to the health care system, he noted.

“Healthcare is an industrial strategy. It’s an investment in the country, it's not a cost centre,” Bond said.

“We have to get out of our thinking about it as just being a 40 percent of budgets go to this thing that’s just meeting a need, to pay for  health care. That just means that we're not investing that $400 billion well.”

“We need to do it smarter. We have to think about returns – returns on productivity returns on performance and returns on health impact.”

Health care data interoperability and portability are crucial

Canada is data rich but information poor, said Todd Foote (photo at right), at St. John’s, Nfld.-headquartered Fonemed, a virtual provider of clinical services and software operating in Canada and internationally.

Yet the Nordic countries are able to share all their health data within domestic organizations that can support – from an aggregate [level], not personal PHI (protected health information) – how that information can help support long-term care, differential diagnosis and preventative care opportunities, he said.

Each province in Canada has its own protection of health data system, including PHI, he pointed out.

To start to change the way health data is shared and used, he added, “We need a federal or a national PIA process that can actually help support that sort of system, where all of a sudden the data can be aggregated by each province and then use the data in a more meaningful way to help support our patient populations. “

“We do need change and we do need change quickly,” Foote said.

He said he sees his children and aging parents going through the local emergency rooms, “sitting there for like everyone across the country for much longer time than then really, they should. It’s a problem that really does need to be fixed.”

The problem can be fixed in a way that compartmentalizes or provides the right local support for the right patient, Foote said, “because right now we're basically trying to push everyone through the same system and it’s not working.”

Cook pointed out that the funding model in health care “is incongruent with adoption of technology.”

This includes mismatched funding cycles between government and health care facilities and providers, along with hospital administrations mostly concerned with the number of patients and beds and “keeping the lights on,” rather than buying new technologies, he said.

“I think there’s fundamentally an incongruence with the funding model and a new  funding model must be introduced to be able to support this [strategic procurement], ” Cook said.

“And I think that creating conditions for permission to buy [Canadian] is critically important for us if we're going to see this as a market that must exist and support to support growth here.”

Canada has limited health care resources to spread across the country, “and we're seeing a lot of pushing and pulling over resources from one province or site to another,” Cook said.  

Instead, what Canada’s health care system should be doing is validating the need [for procurement], improving the appropriateness of care for the patients’ needs at that time, and then also improving access to technologies and other resources, he said.

Cook said transparency and policy really do matter for citizens, and “an empowered citizen is actually much more powerful than a piece of technology. It’s really important we think about patient and family empowerment as part of this next endeavor for the data journey.”

Bill S-5 and pan-Canadian initiatives led by the Canadian Institute for Health Information and Canada Health Infoway on implementing a “connected care” approach are trying to set up elements and layers of data interoperability and portability, he said.

“This would allow people to be empowered with their data and allow providers to trust new applications and systems which hopefully are Canadian-born and Canadian-built and hosted in a sovereign nation data centre.”

All those things together are going to create opportunity economically for the nation, Cook said. “It’s a source of wealth for the nation, and wealth measured in health status of our loved ones is a real thing.”

Bond said health must be give the same priority as defence and national security is being given through the federal Major Projects office.

“When we look at different strategies as a country and nation-building strategy, health as a value chain is immensely important and impactful. We know the cost as a drag if we invest poorly, so it should be looked at as an investment,” he said.

In 2015, a federal advisory panel report on health care innovation called for the creation of a health innovation agency that would take action on the issues Canada’s health care system is still grappling with today, Bond said.

But Canada can’t build innovative health-tech companies without sufficient risk capital and support, he noted.

“And if we don't have procurement, which is the tip of the spear, then there's no target for all of that work. And so we need to make sure that we're thinking about this as a true industrial strategy and how to shift gears.”

The health care systems problems are bigger than any one jurisdictional or industry space, so they need to be solved collaboratively, Bond said.

Health care providers also need to work with their empowered patients “to shift from illness care to health care,” he added.

“There's a lot of work to do and we do have immense Canadian strength. We need to be able to have the courage to match our hopeful ambitions for what we need to be able to do.”

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