By Cindy Liu
The COVID-19 pandemic has brought many government decisions and industries under scrutiny. One industry in particular that has attracted public attention is the healthcare industry. Governments around the world have employed different healthcare responses to treat and contain COVID-19; however, these responses have resulted in notable differences in COVID-19 outcomes, both in terms of death rates and infection rates.
In North America alone, COVID-19 has spotlighted differences between how Canada and the United States have handled the pandemic from a public health perspective. As of July 20, 2020, the U.S. has had over 143,000 deaths and 3.83 million reported cases, or 11,634 cases per million people. In Canada, there have been 8,855 deaths and 110,635 reported cases, or 2,913 cases per million people. In the past week, the U.S. has recorded 66,653 new cases per 100,000 people whereas Canada has seen just 393 new cases per 100,000 people.
While density of population and other non-healthcare factors contribute to COVID-19 outcome disparities, public health experts have emphasized that disparities could, in part, be explained by the differences between Canadian and American healthcare systems and how hospitals are funded and managed.
Canada's centralized and universal healthcare system allows a much greater degree of command and control over the hospital system. In Canada, hospitals operate using global budgets, meaning they receive fixed funding that is independent of the number of occupied hospital beds. Such a system enables public health authorities to “commandeer” the hospital system, for example, by ordering hospitals to prepare for the pandemic by emptying hospital beds.
In the US, however, the privatized hospital system does not receive such orders from authorities and is designed to discourage such actions. Private hospital beds are paid for by patients and insurance; consequently, leaving beds empty would reduce revenue in an already trying economic time. This places U.S. hospitals in the uncomfortable position of having to accept future shortages in resources such as hospital beds in order to avoid immediate financial losses.
According to Professor Peter Berman, a health economist and director of the School of Population and Public Health at the University of British Columbia, the lack of command and control in the U.S. system has also led to problems such as disincentivizing the mobilization of medical supplies and patients between hospitals. Even more severely, the market-approach to healthcare has resulted in direct competition for resources. In April, states were forced into bidding wars against each other and the federal government to buy personal protective equipment (PPE), which left many critical health workers at a shortage of PPE. In response to the bidding wars, the American Medical Association (AMA) urged President Trump and the Federal Emergency Management Agency to establish a national system of PPE acquisition and distribution, which would allow states and hospitals to benefit from, rather than compete with, the bargaining power of the federal government. In general, the COVID-19 pandemic has created a compelling case for policy makers and the AMA that a centralized agency, much like those employed in countries such as Canada, would be better equipped to respond to public health concerns than the forces of the free market.
Additionally, Professor Berman tells the New York Times that without national coordination in the U.S., responsibility is fractured among various agencies and coronavirus task forces, which contributes to confusion and conflicting voices. In Canada, however, Chief Public Health Officer Dr. Theresa Tam, alongside provincial Chief Medical Officers of Health such as Dr. Deena Hinshaw (Alberta) and Dr. Bonnie Henry (British Columbia) are clear spokespeople for COVID-19 related updates and policies.
Health outcome disparities between Canada and the U.S. have been further exacerbated by mass unemployment. Millions of jobs have been lost due to COVID-19 in both Canada and the US, with unemployment peak rates reaching 13.7 and 14.7 per cent, respectively. However, soaring unemployment in the U.S. is coupled with an estimated 5.4 million American workers losing their health insurance, which more than half the U.S. population received through their jobs. The Kaiser Family Foundation estimated that when dependents like spouses and children are included, the number of people who lost employer-sponsored health insurance rises to almost 27 million. While recently unemployed Canadians can fall back on universal health care, millions of Americans have been stranded and left uninsured during a time when the need for adequate and affordable healthcare should be prioritized.
None of this is to say that Canada's COVID-19 response or healthcare system are perfect. COVID-19 has accentuated Canada’s lag in telehealth infrastructure, especially compared to the massive acceleration of both provider and consumer adoption of telehealth in the U.S. since the outbreak of COVID-19. The pandemic has also highlighted key flaws shared by the Canadian and American healthcare systems, including the disproportionate percentage of deaths linked to long-term care (LTC) facilities. According to an analysis released by the Canadian Institute for Health Information on May 25, LTC residents accounted for over 80 per cent of all reported COVID-19 deaths in Canada, nearly twice the average rate of other OECD countries.
So what does this mean for healthcare systems post-COVID-19? The stark disparities in COVID-19 outcomes between the American and Canadian systems have catalyzed the loss of confidence in privatized approaches to healthcare. The pandemic has clearly shown the need for universal access to affordable and accessible care. The failures of the current U.S. system, which left millions uninsured, hospitalized or dead, provide a strong argument in favor of adopting successful aspects of the Canadian system. In particular, the U.S. should redefine how healthcare is governed and paid for and establish a new system that allows swift, coordinated action that is driven by public health officials, not politicians.
Healthcare, like all other industries, will never return to the “old normal.” Now, more than ever, we are in the unique position to reimagine the future of healthcare.