Canada is rightfully proud of its healthcare system. What started out as hospital insurance for the people of just one province around 50 years ago, has now blossomed into Universal Healthcare for 38 million people.
Innovation is everywhere you look in Canada’s healthcare system but scaling solutions across provincial borders has been historically difficult. In theory, a single payer system would make it easier to facilitate innovation, but the reality is that federal-provincial-territorial collaboration has been challenging in practice.
Before the COVID-19 pandemic, timelines for changes in the Canadian healthcare system were discussed in terms of years, not weeks. Canada was slow to adopt models such as value-based care, virtual care, even multi-disciplinary team working. During the pandemic, rapid system transformation occurred. Virtual care became the new normal. Hallway medicine abruptly disappeared. Innovative models of care were adopted. A recent report from KPMG found that 81% of Canadians believe the pandemic has forever changed the delivery of healthcare for the country[i].
Dr. Mark Britnell
Primary care, in particular, had to rapidly evolve during the pandemic in order to ensure the health and safety of clinicians and staff while remaining connected to patients. Family doctors rose to this challenge and quickly adapted to virtual care. The Canadian Institute for Health Research (CIHI) reported that 52% of patient visits took place virtually in April 2020. However, despite these advances, 25% of British Columbians have not seen their doctor or have seen them less frequently since the pandemici. Moreover, Black Canadians, Indigenous people and people of colour, have reported greater levels of dissatisfaction with the virtual care they have receivedi. This adds a level of complexity to a long-standing issue for the Canadian healthcare system – equitable access to primary care.
Prior to the pandemic, about 1 in 6 British Columbians reported that they did not have access to a regular family doctor. While it’s tempting to frame the problem in terms of a shortage of family doctors, this group currently makes up over half of the physician workforce in the country. Family medicine in Canada does not have a numbers problem, but rather current delivery models for primary care are still physician centric, despite the adoption of virtual care. Predominant fee-for-service (FFS) renumeration models tend to incentivize volume, can sometimes inhibit preventative care and underutilize other allied professions, such as nursing and physiotherapy.
British Columbia (B.C) is tackling this issue head on. In September 2020, the government announced that 22 primary care networks would be coming throughout the province. These networks aim to ensure that all patients have access to a full range of team-based primary care services. The network teams will include family physicians, nurse practitioners and other health-care professionals, ranging from cultural safety facilitators to clinical pharmacists. Indigenous partners have been involved in the development of these networks from the start, advising on everything from planning to governance. It is estimated that these networks will help connect over 300,000 British Columbians to primary care providers in the coming years[ii]. In addition, 24 urgent and primary care centres have been opened to date. These centres provide access to same-day, urgent, non-emergency primary health care.
While the pandemic has served as a powerful catalyst for change in the Canadian healthcare system, further integrating primary, secondary and community services will challenge working models even more. Innovations such as team-based care, changes to the scope of practice for nonphysician health professionals and alternative forms of remuneration like capitated models, as well as continuing to build on virtual care delivery are all viable options for primary care reform and need to be scaled across the country. To this end, the Federal government has promised to provide $400 million over the next four years to help expand virtual care. Canada must continue to capitalize on the momentum generated by the pandemic and take bold action to move the country’s healthcare system from innovation to implementation.