Feds have role to play in modernizing Canada’s health-care systems

Health care is a provincial responsibility. A national role in health care would have been incomprehensible to our founders, as health care was delivered locally in 1867 by caregivers who physically visited their patients. This delivery method has changed dramatically in recent times, creating a legitimate national role for the federal government to push forward the modernization of health care in Canada, and globally. The modernization of clinical practice has many dimensions: digital health, national licensure, virtual care, and best practice and quality indicators are among them. Fundamentally, the rise of information technology makes it possible for clinicians to standardize and improve their practice and, in some instances, has broken the physical link required to deliver care. Because we can now care for patients at a distance, provincial and territorial boundaries become less important and it becomes sensible to talk about national economic development, national licences, sharing health human resources, national quality, and access standards. Previous papers by the C.D. Howe Institute have focused on modernization at the provincial government level, but there is a role for the federal government in setting and achieving national priorities. Health care is now a global knowledge industry and Canadians are among the leaders. Our research hospitals and universities are world-class, and we train a large number of physicians practicing in the Middle East and elsewhere. Our accreditation services, our professional colleges’ services, and our clinical best practices are exported to other countries. Countries looking to build national health-care systems look to Canada as an example. Ironic, given that we do not actually have a national system. Canada’s opportunity to export clinical practice, education, and standards will continue to expand. One model to look at is what has happened in universities and colleges. In 2017, 12 per cent of Canadian post-secondary students were international. This understates the economic impact, because generally international students pay much higher fees than Canadian students. Canadian academic hospitals have been quietly doing the same thing for resident physicians for years now. If we exported 10 per cent of health-care goods and services, Canada would “export” $25-billion. This compares to current pharma/medicine and medical equipment manufacturing, totalling $13-billion in 2018. The opportunity around health-care services is significant. The digital revolution in health care makes possible new ways to access this economic opportunity. Codified knowledge and best practices are embedded in standards, quality indicators, and pathways. Our former international students and colleagues take these knowledge products and make their national systems better. Virtual care allows clinicians to “care” for patients half a world away. In specialties such as radiology and pathology, virtual care has been evident for a decade. As virtual care expands, the opportunity for Canadian physicians to treat patients in other countries will also expand. These are good, clean knowledge economy jobs. We are proud of our nation’s health-care leadership and should seek to be leaders internationally as the industry becomes more global. To export our health-care system, we need to get our own house in order. The federal government can play a role in leading this in a number of ways: National licensure, as the Canadian Medical Association has advocated. One clinical licensing regime would improve labour mobility domestically and serve as a base for the export of clinical services and licensure itself. Accreditation Canada and the Royal College of Physicians and Surgeons of Canada are actively expanding internationally. Virtual care needs national endorsement as a covered health-care service. Indigenous health care involves serving highly dispersed and often-remote populations. Federal leadership in creating a modern system for these communities should remain a top priority. National reporting of quality and access indicators needs a renewed commitment. Previous Liberal commitments under the Martin and Chrétien governments have been whittled down by federal and provincial machinery. The alphabet soup of pan-Canadian agencies needs rationalization and reorganization to promote best practice, digital health, and quality/access reporting. A patient’s right to a usable version of their digital health records should be endorsed as a national expectation. Implement the recommendations from the Naylor Report on health innovation. View immigration of health-care professionals and international student recruitment as an economic development opportunity. Local health-care delivery can remain provincial, but labour, product, and service standards for export need federal leadership and support. National standards, digital modernization, and national licensure would give us a way to improve Canada’s leadership role in global health care and build an improved and more national health-care system domestically. Will Falk is a senior fellow at the C.D. Howe Institute. The Hill Times