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Yahoo
6 days ago
- Business
- Yahoo
Opinion: We need to try doing health care the Swiss way
By Yanick Labrie Last year marked the 40th anniversary of the Canada Health Act, long considered a pillar of Canadian identity. But today, that symbol is showing signs of strain. Despite record government spending, health-care wait times have reached historic highs — more than 30 weeks on average for planned treatment — and access to care continues to deteriorate. Fewer than one in five Canadians now says the system works well. While political leaders tinker at the margins, countries such as Switzerland have taken bold steps to build universal health-care systems that are more responsive, more flexible and, above all, more accessible than ours. Switzerland achieves universal health coverage with a patient-centred model. Instead of relying on a government monopoly, the Swiss system is organized around principles of regulated competition. Forty-four private, non-profit insurers offer standardized basic coverage and, though everyone must enrol, Swiss choose their insurer and are free to switch plans twice a year. This freedom of choice drives insurers to innovate, tailor benefits and ultimately improve service. Switzerland's universal system is also more comprehensive than Canada's, covering not only hospital and physician services but also prescription drugs, mental-health care and some long-term care services. Patients can manage care based on their own preferences, choosing from a variety of plans with varying deductibles and premiums. By contrast, the Canadian system offers virtually no choice. The government enrols every citizen in the same plan, with the same benefits, on the same terms. The Canada Health Act, meant to promote equity, prohibits flexibility. It's a lowest-common-denominator model: rigid, bureaucratic and unresponsive to patient needs. Nowhere is this clearer than in the way we access care through compulsory gatekeeping. To see a specialist, patients must go through a family doctor. But six million Canadians don't have a family doctor. For them, this requirement isn't just inconvenient, it's a dead end. The result is long delays, lost diagnoses and growing public frustration. The Swiss model, driven by patient choice and regulated competition among insurance providers, prioritizes adaptability. Because residents can switch insurers and choose from among different care models, insurers have an incentive to innovate in response to evolving needs. As a result, patients can opt for: a standard model with no gatekeeping, managed care with family doctors, pharmacy-based co-ordination, telemedicine-first or other models. And they don't have to wait long. According to the latest Commonwealth Fund survey, 76 per cent of Swiss residents can see a doctor or nurse within five days, compared with only 46 per cent of Canadians. Having different plans not only expands choice but also helps insurers control costs by reducing unnecessary consultations and hospitalizations. Studies show that such models can lower the cost of care by up to 34 per cent without compromising quality. They also encourage providers to focus on prevention and chronic care management, which increases efficiency, improves outcomes and allows insurers to reduce premiums and control long-term spending. In fact, despite the greater choice and broader package of health-care services than in Canada, real per capita health-care spending in Switzerland has grown by less than two per cent a year since the mid-1990s, compared with 2.7 per cent in Canada. These Swiss facts likely are music to the ears of Canadians. But how much do the Swiss pay out-of-pocket for health care? Patients do share some costs through deductibles and co-payments, but costs are capped and vulnerable populations (children, pregnant women, low-income people, etc.) are exempt. In 2022, average annual out-of-pocket spending per insured person in Switzerland was 581 Swiss francs, equivalent to $792 at that time. For people who don't require much care, the costs are much lower or even zero. And nearly 28 per cent of the population receives subsidies to cover their premiums. Many Canadians assume our system is 'free,' forgetting it's funded by taxation. They also tend to overlook significant out-of-pocket costs not covered by the public system (prescription drugs, mental-health care, long-term care, etc.). The Canada Health Act prohibits co-payments and mandates uniform public insurance so a province could copy-and-paste the Swiss model only at risk of losing federal transfers. But Switzerland's system shows that universality isn't incompatible with choice and competition, which can in fact strengthen each other. When patients are free to choose, providers have to be more efficient and more responsive to their needs and preferences. Opinion: Hospitals need to be up front about unsafe wait times Matthew Lau: If health care is a right, why can't we get it when we need it? Canada's health-care debate has long been framed as rigidly either/or: either a government monopoly or a privately-funded U.S.-style system that abandons universality. This mindset has stifled innovation and made it harder to build a system that is both universal and responsive. The Swiss model, which reconciles equity, choice and adaptability, is a guide Canadian policy-makers can no longer afford to ignore. Yanick Labrie, senior fellow at the Fraser Institute, is author of the new study Building Responsive and Adaptive Health-Care Systems in Canada: Lessons from Switzerland.
CBC
05-05-2025
- Health
- CBC
Forcing treatment for drug use could lead to overdoses, violate people's rights, experts say
Social Sharing Some experts say involuntary addiction treatment raises serious ethical concerns and could even increase the risk of overdose for some, as Ontario weighs whether it could mandate treatment for people in the criminal justice system. Last week, the Ontario government announced that it plans to study how this can be done, how much it would cost, and what kind of help they would need from the federal government, among other factors. But those working in the addictions and mental health field say there's little to no concrete evidence suggesting involuntary addiction treatment is effective. "That type of research really hasn't been done," said Sarah Dermody, a clinical psychologist and professor of psychology at Toronto Metropolitan University. "So we're in a position where people are advocating for involuntary treatment, we have some theoretical concerns and ethical concerns of that approach, and we don't have empirical evidence to suggest that it would be helpful in the short or long term." In some cases, such as with people facing opioid addiction, it could even present risks of overdose if they return to using when their tolerance is lowered, Dermody said. "If someone you know was using a certain dose and then returns to it several weeks later, that could be life-threatening for them." Data from Massachusetts, where there is a legal mandate for involuntary treatment for adults with substance use disorders, published in 2016 found the risk of fatal overdose was twice as likely after involuntary treatment compared to voluntary treatment, according to information compiled by the Canadian Mental Health Association (CMHA). Another Massachusetts study from 2023 that looked at 22 patients after they completed involuntary treatment found they all relapsed within a year. Those studies suggest this type of approach can be "more like sort of holding someone than actually helping and treating someone," said Dr. Leslie Buckley, chief of addictions for the CMHA. "It was supposed to be a diversion, but it looked a lot more like the regular criminal justice service system and there wasn't necessarily a helpful treatment component to that," she said. "So I think that that the most important critical piece here is that it is a health-focused intervention and that we're thinking about how we can prevent somebody from getting involved in the criminal justice system earlier." Chris Cull, a substance use disorder advocate who was once addicted to opioids for nearly a decade, says the government shouldn't even be discussing involuntary treatment until it addresses the need for treatment options for people who do want it. "We don't even have enough voluntary treatment beds to be able to be manage what we have in society, as it is, for people who want it," he said. Ethical concerns An expert on bioethics says forcing people to undergo addictions treatment also goes against a core tenant of the Canada Health Act, which says consent is required for virtually any medical treatment. "Each and every one of us Canadians has the right to consent or decline treatment of any kind," said Kerry Bowman, who teaches bioethics and global health at the University of Toronto. "The fact that people are facing criminal charges does not necessarily change this. Yes, they've lost some of their rights, but that doesn't necessarily mean they've lost their right to consent for treatment." From an ethics standpoint, Bowman said there would need to be evidence showing that the benefits of involuntary treatment outweigh the potential harm to individuals. "To take away someone's fundamental rights to make decisions about treatment, which is the integrity of the of their own body and their own freedom, in the absence of compelling evidence is really going very far," he said. In a statement, a spokesperson from the Ministry of Health said the province is "collaborating with a number of key community stakeholders and partners to ensure a coordinated approach for justice-involved individuals." The government's announcement was one of many measures connected to a large justice bill set to be tabled last Thursday. The move toward involuntary addiction treatment for people in corrections isn't inside the legislation itself, but officials say they intend to present a plan to the cabinet by fall.
CBC
26-04-2025
- Politics
- CBC
The 2025 federal candidates in brief: Thunder Bay—Rainy River riding
Social Sharing Thunder Bay—Rainy River is commonly referred to as the "south side riding" within Thunder Bay as it includes the part of the city south of Highway 11/17 and the Harbour Expressway but it also stretches west to Lake of the Woods, and north to Brightsand River provincial park covering an area of about 30,000 square kilometres and a population of over 80,000. It also includes Atikokan, Fort Frances, Rainy River, Neebing, Oliver Paipoonge, Alberton, Chapple, Conmee, Dawson, Emo, Gillies, La Vallee, Lake of the Woods, Morley, O'Connor and the Unorganized Area of Rainy River. Several First Nations fall within Thunder Bay—Rainy River, including Fort William First Nation, Big Grassy River, Couchiching, Lac des Mille Lacs No. 22A1, and Seine River No. 23A. CBC reached out to all the federal candidates to request summaries of key election issues as identified by northwestern Ontario voters. The candidates and their responses are listed in alphabetical order by surname are as follows: Eric Arner, Green Healthcare, including but not limited to primary care, mental health and addictions: " Ontario is suffering from intentional underfunding by the Ford government in an effort to push private care. Green party would enforce the Canada Health Act to ensure federal funds are spent only on public care." Cost of living, including but not limited to housing affordability and taxes: " Dramatic income tax reduction for those earning less than $100 000." "National minimum wage index calculated regionally based on essential expenses." Housing and Homelessness: " Crown Corporation dedicated to building affordable housing." "Housing-first strategy provides housing with wraparound services to help people transition from temporary to permanently housed." First Nations issues, including but not limited to infrastructure and mental health: " Implement all 94 Calls to Action from Canada's Truth and Reconciliation Commission." US-Canada relations, including but not limited to tariffs: Did not provide a response Brendan Hyatt, Conservative Healthcare, including but not limited to primary care, mental health and addictions: "Introduce the Blue Seal Program to fast-track foreign-trained doctors and nurses." Cost of living, including but not limited to housing affordability and taxes: "Axe the carbon tax." "Cut the lowest income tax bracket to 12.5%." Housing and Homelessness: "Remove HST on new homes up to $1.3 million." "Sell off 6000 federal buildings to build new homes." First Nations issues, including but not limited to infrastructure and mental health: "Establish the Canadian Indigenous Opportunities Corporation, led by Indigenous people to offer loan guarantees for Indigenous communities." US-Canada relations, including but not limited to tariffs: Marcus Powlowski, Liberal Healthcare, including but not limited to primary care, mental health and addictions: "Recruiting more doctors, cancer care funding, improving support for mental health and addictions." "Protecting healthcare from cuts." Cost of living, including but not limited to housing affordability and taxes: "Lowering living costs through tax cuts, childcare, affordable housing." Housing and Homelessness: "Doubling housing construction, building co-op housing, investing in transitional housing." First Nations issues, including but not limited to infrastructure and mental health: "Backing Indigenous self-determination." "Access to clean water, healthcare." US-Canada relations, including but not limited to tariffs: "Fighting tariffs and reinvesting tariff revenue in Canadian workers." Sabrina Ree, PPC Healthcare, including but not limited to primary care, mental health and addictions: "[Prioritizing] patient-centered healthcare, fiscal responsibility and innovation." Cost of living, including but not limited to housing affordability and taxes: "[Cutting] carbon and federal taxes, saving farmers $150,000 yearly, and deregulate zoning for affordable housing." Housing and Homelessness: "Pause immigration, remove GST on construction, and streamline land use approvals." First Nations issues, including but not limited to infrastructure and mental health: "Support First Nations infrastructure through private investment, market-driven mental health solutions, and self-governance." US-Canada relations, including but not limited to tariffs: "[Opposing] U.S. tariffs, champions free speech, removes trade barriers and ensures pipeline access." Yuk-Sem Won, NDP Healthcare, including but not limited to primary care, mental health and addictions: "Continue to expand universal care—Dentalcare and pharmacare; imagine getting mental healthcare with your health card not a credit card!" "To ensure proper funding and staffing for hospitals, long term care and paramedic." Cost of living, including but not limited to housing affordability and taxes: "Affordable: cap rent, grocery hikes, and make the rich pay their share." Housing and Homelessness: "Housing is a right—build non-profit, sustainable, affordable homes." First Nations issues, including but not limited to infrastructure and mental health: "Reconciliation—real funding, real consent, real partnerships." US-Canada relations, including but not limited to tariffs:
CBC
14-04-2025
- Politics
- CBC
Know your riding — Canada Votes 2025: Niagara South
This election will be the first for the newly named riding of Niagara South. Much of the region was in the riding of Niagara Centre, but redistribution in 2023 significantly changed the southeast boundaries, adding about 35 per cent from what was previously the Niagara Falls riding. The new Niagara South riding contains the cities of Port Colborne, Thorold and Welland and the Town of Fort Erie. It's bordered by Lake Erie to the south and partly by the U.S. border in the east. The redistribution may give the Conservatives an advantage in the federal election, according to a CBC analysis of 2021 election results. Liberal candidate Vance Badewey won the 2015, 2019 and 2021 elections for Niagara Centre and will run again, this time for Niagara South. CBC Hamilton sent a survey to major party candidates, or their party representatives. Their responses, edited for length and clarity, are reflected below. Vance Badawey, Liberal Before he was elected as MP in 2015, Badawey, 60, was the Mayor of Port Colborne and a councillor for the Niagara region. He said, in the survey, he's helped get investments worth $3.7 billion in the riding. "I've fought to keep urgent care centres open, supported the rise of new local industries and helped create thousands of good-paying jobs for families right here at home," Badawey said. He said in the survey he's running again "to take the politics out of politics — and focus on the business of the government." Natashia Bergen, Green Natashia Bergen is a cannabis grow technician and graduated from the University of Guelph with a horticulture certificate, according to her LinkedIn. She did not fill out the survey and more information about her is not readily available online. Fred Davies, Conservative Fred Davies has been a business leader in the Niagara region for four decades, has served as a school board trustee and is currently a regional councillor, says his campaign profile. He did not respond to the survey. "Known for his hands-on approach to business, Fred knows what it takes to create jobs and support families," says his website. "As a business mentor, Fred has guided many young entrepreneurs to help them achieve their entrepreneurial dreams." Chantal McCollum, NDP McCollum, 43, is a lawyer and previously worked as an environmental consultant. She said if elected, she would fight to protect public health care by enforcing the Canada Health Act. She'd push the federal government to play a more "active role" to keep "critical health services in place" in Fort Erie, Port Colborne and Welland. "I would also fight to ensure all levels of government work together in implementing policies to make life more affordable, including but not limited to expanding the availability of affordable housing," she said in the survey. Peter Taras, People's Party Peter Taras, 52, has a master's degree in organic chemistry, owns a greenhouse and operates a garden centre. He said in the survey people should vote for him and the People's Party of Canada this election because it "puts Canadians first." The party will focus on deporting people "here illegally and reduce the burden on Canadian taxpayers," he said. "Additionally, we are calling for a moratorium on immigration, until our housing prices stabilize." The PPC will also strengthen border security and end the trade war with the U.S. by removing all tariffs on American products, Taras said. Also running
CBC
12-04-2025
- Health
- CBC
Health care's taking a backseat in this election. That's a missed opportunity, expert says
Social Sharing In this federal election period, the twists and turns of tariffs, annexation threats and other surprises from the Trump administration have stolen focus from addressing the state of public healthcare in Canada. A leading expert on health law and policy experts says that's a shame. "We are in an emergency situation in Canadian health care, and we have been for a couple of years post pandemic," said Colleen Flood, who is also dean of law at Queen's University. An estimated 6.5 million Canadians don't have access to a family doctor and one-third of those who do find it difficult to get an appointment. Patients waited 222 per cent longer to see a specialist in 2024 than they did in 1993, ranking Canada the worst in wait times of all high-income universal healthcare countries. Across the country, more Canadians are paying out of pocket for health care that the Canada Health Act says should be available to them in the public system. Virtual private-pay family medicine is readily available, and most provinces and territories now have in-person clinics as well. In November 2024, CBC Radio's White Coat, Black Art visited a busy private-pay family medicine clinic in Vaudreuil, Que., where patients pay $150 to see a family doctor for 15 minutes. Flood told White Coat, Black Art host Dr. Brian Goldman that this election is an opportunity for voters to demand the next federal government provide Canadians with the healthcare they need. Here is an excerpt from their conversation. The Canada Health Act includes an expectation of "reasonable access" to healthcare. Can you define it? We all have a sense of what the bare minimum is, right? We want access to a family care team or a family doctor. We all want access to tests and diagnostic methods and specialists and hospitals within a reasonable time period. The Canada Health Act sets out criteria: reasonable access, which is a bit of a joke at the moment; comprehensiveness, of hospital and physician services, effectively; [and] portability — you should be able to get health care where you need it across Canada. The only way those criteria can be enforced is if the federal government uses its discretion to withhold money. The feds have never used their discretionary power to keep back money from a province that is allowing wait times to grow or not ensuring that everybody has access to a family doctor…. They're quite nervous about using a hammer rather than a carrot to get where they want to go. WATCH | Lining up for a chance to get a family doctor: Hundreds wait in the snow to get a family doctor in rural Ontario 3 months ago Duration 2:03 You have written extensively about how the Canada Health Act could be strengthened or at least better enforced. Have a go at that. That's a lovely thing to talk about. The Canada Health Act has been an incredible tool for Canadians since [former Minister of Health and Welfare] Monique Bégin brought it to pass. But it needs to evolve, in particular around reasonable access. I think the Canada Health Act should be overhauled so that the federal government requires the provinces to have a fair, transparent process to determine what reasonable access is. What does that mean for us in New Brunswick, in Manitoba, in Saskatchewan in terms of access to a family health-care team or a nurse practitioner or a primary care doctor? In terms of maximum wait times, in terms of coverage?…. And then this is revisited from time to time to make sure that it's updated to change with our needs, because our needs do change. Any idea what the federal parties are saying about what's happening in this current election environment? With the very serious situation in the U.S., health care is unfortunately taking a back seat. And that is a real shame because we are in an emergency situation in Canadian health care, and we have been for a couple of years post pandemic. We need the parties to speak to their plans for improving public medicare. And Canadians must hold their feet to the fire on this. I counsel everyone to ask their candidates about what they specifically will do to make sure that everybody has access to the care that they need. A lot of public health care in Canada came to pass after the Depression and World War II, where people realized that medicare should be available to everybody. So maybe this will actually bring us together more around the importance of public health care, that we need to protect it. What would you like to see the party leaders saying about the future of health care during this election period? Honestly, I'd like to see them say anything about what they will do. Conservatives may involve more private for-profit care inside of public medicare. The Liberals may involve more of a [mix] of getting there. The NDP may prefer more public hospitals, perhaps more salaried physicians, and moving more to an NHS-style system like you see in the U.K. Everybody may have their different recipe for improvement, but I think that's what Canadians need to hear: What are your plans? What will you actually do? And how will you ensure that myself and my family are going to be able to get the care when we need it? I want to close by asking you, what should voters be listening for during this election period when it comes to health care? Voters should be looking to parties to acknowledge that we are actually in a crisis, we're in an emergency, and that we need to take very significant steps very quickly to fix medicare. It is simply unacceptable that 6.5 million Canadians do not have reasonable access to the most basic of care, family medicine. It is even worse than that they are queuing up and desperate for care, clogging up ERs and so on, waiting to a point where the condition that could have been dealt with has got away on them. So what we want to see is that the parties are taking this crisis, this emergency, extremely seriously, and they have a serious plan to deal with it.
