Expanding Telehealth to Support Gaps in Canada’s Medicare System

Whether you’re against “socialized” medicine, or a fan, for better or worse, Canadians have their own unique way of providing healthcare that’s different from the American system we live with. Interestingly, Canadians are vocal in both their praise and disgust with the current system – just like Americans are here at home.

There is considerable debate across the provinces about their single-payer universal healthcare system, which The Washington Post suggests is an “unrivaled pillar of Canadian national identity.”

No, it’s not Wayne Gretzky, but instead a system of “Medicare for all” that Canadians think of when describing their way of life. However, the system, which is funded by taxpayers, has come under fire recently as having “abysmal health outcomes for Canada’s 1.7 million indigenous people,” according to an article in The Lancet.

This article will look at the pros and cons of the current Canadian “normal” for their publicly funded healthcare system and discuss how any expansion of technologies such as telehealth could help correct some of the problems and modernize one of the oldest public health systems in the world.

“While Canadian values of solidarity, inclusivity, and diplomacy have found much expression in matters of health, there are clear signs that all of the world now ‘needs more Canada’.”

“Canada’s Time to Act”
<a href=”https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30176-4/fulltext”> The Lancet

Jocalyn Clark – Richard Horton
February 22, 2018

The Canadians call their publicly funded healthcare system “Medicare.” But one misconception is that their version of Medicare is a government-run system. In fact, there are currently 13 healthcare plans under the Medicare system, which provides care without out-of-pocket costs.

While that doesn’t mean the care is free, it does mean that everyone is covered. However, it also doesn’t mean that everything is covered, which is why two-thirds of Canadians have supplemental private insurance, which covers vision, dental, prescription drugs, home care, ambulance services, and so on.

This public method of providing care to citizens has been used as an example in our country on either political extremes ranging from “socialized medicine” to a utopia of free healthcare for all. But the truth is somewhere in between.

A less cliché-driven analysis of the Canadian system shows both pros and cons to living under it. While everyone is offered care, The Washington Post suggests two big problems with the Canadian system:

• A recent study showed that Canadians struggle with prescription drug costs in the same way that Americans do.
• Canadians face long wait times for non-emergency and specialty procedures such as a hip or knee replacement.

Benefits Canada published an article a few years ago about living under their version of Medicare. In it, the authors cite the following pros and cons of their healthcare system:

Medicare Pros

All Canadians can receive healthcare.

Health outcomes are higher than the U.S.

Far fewer taxpayer dollars go to administration over actual healthcare than in the United States.

Medicare Cons

It’s not cheap.

Governance of the system is politicized, so decisions are made based on popularity not fiscal responsibility.

Access to care is a significant problem with long wait-lists for treatment.

Healthcare funding is not consistent and regulated by province. This has left big gaps in care for Canada’s indigenous peoples, who live in some of the poorest provinces.

But it is the issue of access to treatment that seems to be the latest lightning rod issue with Canadians, as indicated in a new study from The Lancet.

A study in the Health Policy journal suggested that “Many rural communities across Canada are facing sustainability of core emergency and acute care health services, primarily due to problems with medical and nursing staffing.” Further, family practice docs have pulled out of rural communities, maternity care units have closed, and ERs have limited hours to save costs. According to the study, approximately 10% of the small rural communities in Canada have been designated “communities in crisis,” because access to healthcare is simply unavailable. Many of these communities are, in fact, where the indigenous tribes of Canada call home.

Ironically, the issue of access and the cost of care is something shared between the United States and its northern neighbor. Like the U.S., Canada has turned to telemedicine as a way to improve access to care and cut costs.

“Many of the basic principles embedded in the Canada Health Act still work. However, this important piece of legislation needs to be modernized to reflect the realities of today. The principles of public administration and the guidelines for what is “medically necessary” in particular need to be reviewed to ensure that whether what was anticipated in 1961 still works today. And we need to ask the hard questions—the questions no politician wants to ask—to ensure that we establish the most appropriate path for our future.”
Brian Lindenberg
Benefits Canada

In 2011, Gartner conducted a study on the use of telehealth across Canada, where they found “significant and growing utilization of Telehealth.” While reporting across the provinces is sometimes problematic, the most recent data showed:

• Telehealth applications saved ill or elderly Canadians located in rural communities 47 million travel miles annually.
• Telehealth saved $70 million in personal travel costs.
• Store-and-forward telehealth applications reduced wait times for crisis counseling, endocrinology, dermatology, ophthalmology, and more.
• Telehealth was an effective communication tool during the 2003 SARS and 2009 H1N1 public health crisis.
• Telestroke consultations improved outcomes at small, rural ERs around the country.
• More than 80% of patients reported being satisfied with their telemedicine visit.
• Telehealth reduced inpatient admissions and “cost avoidance” for healthcare systems, saving an estimated $55 million each year.

The study concluded with a prediction that the future state of telehealth applications in Canada will improve access to care while each year saving approximately $730 million for the health system and another $440 million in cost avoidance for patients.

In researching Canada’s healthcare system the ironies cannot be missed; while the frameworks for providing care are strongly different between the two countries, there are strong correlations in our struggles to control costs and provide access to our rural communities. It seems that telehealth holds the same promise to eliminate these issues, whether the healthcare is provided by a private U.S. hospital system or a national taxpayer-funded Canadian system of care.