Health Care Funding in Canada — Dr. Jennifer Zelmer and Flavie Laliberté

Alya Niang

Canada’s ailing health care system received a massive cash injection in early 2023. Ottawa will be providing an additional $46.2 billion per year over the next 10 years in transfer payments to the provinces and territories. More than half of that amount is aimed at increasing the number of family doctors, hiring more health care workers, helping more Canadians with mental illness and addiction issues, and modernizing patient medical records.

Jennifer Zelmer

We all want primary health care that we can access when we need it. We all need to be assured that there’s support for health care professionals, who play a truly essential role in the services we need.

Alya Niang

How can the provinces prove, with data, the benefits that patients will see? In this episode, we ask the question: what real changes can be made to the Canadian health care system?

Flavie Laliberté

I don’t want to have 10 different apps to talk to my pharmacist, my doctor, my clinic and my hospital. I want 1 place where I can access all that information and contact them. That would also help people who have a hard time with technology. Instead of having to go to all these different places, they’d just need to learn how 1 works. It would make things easier for patients and their caregivers.

Alya Niang

Hello, and welcome to the Canadian Health Information Podcast. I’m your host, Alya Niang. Please bear in mind that the opinions and comments of our guests do not necessarily reflect those of CIHI, but this is a free and open discussion. Today’s episode is about the latest health care agreement. Will this new funding and accountability strengthen our health care system? Joining us today are Jennifer Zelmer, President and CEO of Healthcare Excellence Canada, and Flavie Laliberté, a patient partner and fervent advocate of digital health.
Welcome to the podcast, Jennifer. Welcome to the podcast, Flavie.

Jennifer Zelmer

Thank you, Alya.

Flavie Laliberté

Thank you.

Alya Niang

So, part of this discussion involves trying to understand what all this new federal funding is going to do for Canadians. In other words, what are we going to get out of it? Let’s start by looking at the big picture, Jennifer. We know that the provinces and territories have insisted that they need more money for health care, and this represents $46.2 billion in additional funding over the next 10 years. How important is this funding?

Jennifer Zelmer

The provinces, territories and federal government reached a consensus on 4 main objectives for how the funding will be used. The first is to expand access to primary care, or family medicine, that’s close to home, including in rural and remote areas. The second is to support workers in the health care system, and that includes finding ways to reduce backlogs for surgical and other types of procedures. The third objective is to improve access to high-quality mental health and substance abuse services, and finding ways to organize services to promote greater well-being. And lastly, the fourth objective is to truly modernize our health care systems through standardized health information, and that includes access for all Canadians to their own information, such as lab test results. Those are essentially the 4 objectives that are central to this effort.

Alya Niang

Let’s talk about some of the key areas that Ottawa would like the provinces and territories to focus on. The first is family medicine, or basic primary care, across the country. Why is that a priority, Jennifer?
Jennifer Zelmer
I think primary care is the foundation of the health care system. It’s the first stop. It’s where you go when you have a health issue. So, having solid primary health care is the right starting point for the health care system. And we know that, here in Canada, but also based on data collected around the world, it’s absolutely essential for a health care system that aims for excellence.

Alya Niang

Since 6.5 million Canadians across the country don’t have primary care, it really is a priority. And the second priority is rebuilding the nursing and medical workforce. That one is fairly clear. Jennifer, from your perspective, what are you seeing see in terms of shortages, and how is that situation developing?

Jennifer Zelmer

There’s a shortage of health care workers all over the world. It isn’t only affecting Canada, but it’s certainly a challenge here. We were facing it before, but the pandemic really exacerbated it. And health care workers are the core of the health care system. That’s the crux of the problem. So, we really need to focus on recruiting, but also on support for workers so they can deliver safe, high-quality health care. And that’s their goal too. It’s really about finding ways to support them.

Alya Niang

The third priority area is mental health and addiction. Every day, we hear about people and record numbers of overdoses, as well as long wait times for mental health care. Clearly, this is a priority. How important is this objective?

Jennifer Zelmer

Health care absolutely includes mental health. So, it’s important to look at how we can support mental health for the entire population: young people, seniors and everyone in between. And we know that there’s an opportunity to really look at addiction services too. It’s a challenge that has also exacerbated, and it’s one that’s particularly important to focus on because we have the opportunity, with research-focused care and people-centric services, to really make a difference.

Alya Niang

The last objective involves medical records and modernizing our health care systems. We’ll talk about that in a bit more detail when Flavie joins us. But in general, when you look at this agreement and this additional funding, Jennifer, how quickly do you think it’s going to lead to change on the ground for Canadians?

Jennifer Zelmer

Data is important at the system level, of course. And there are many indicators that come with these agreements, which have gotten a lot of attention. But data is important for us, too. It’s information about our health and the way for us to be a part of the health team to keep ourselves healthy. So, access to our own files is a starting point for our participation as well.

Alya Niang

How quickly do you expect to see results? Because I know a lot of people are waiting to get a doctor or a nurse practitioner, including myself. My family doctor retired and now I’m looking for another one. Do you expect to see results soon?

Jennifer Zelmer

Everyone wants access to the care they need now. And that access isn’t a temporary thing. It’s for the long term as well. The situation isn’t exactly the same from one place to another in Canada. There are places that have had some success, and we can learn from them so that people like you, and others who don’t have a family doctor right now, get access to the care they need. Whether it’s a doctor or a family health care team, there are many different ways to make sure you have access to primary health care that’s truly focused on your needs.

Alya Niang

1 of our priorities is to modernize the health care system. And I know that many Canadians are wondering what that means. Flavie, let’s turn to you. You wrote an article that was shared at the e-Health Conference. It’s entitled “Lost in the Health Care Maze: One Pregnant Woman’s Agonizing Quest for a Simple Referral.” Can you tell us a bit about your misadventure, if I can call it that?

Flavie Laliberté

Yes. I was 8 months pregnant and my OB/GYN referred me to the hospital for a totally normal, routine test. So, I take my referral to the hospital. The hospital tells me: “Unfortunately, there’s a mistake. Your doctor needs to redo it.” There was a signature missing. So I thought, “Fine. I’ll call my clinic.” Well, no one answers. There’s no way to leave a message, no way to send an email, no way to say: “I just need a simple signature. It’s no big deal.” So I call again. And again. I call again the next day. And I call again after lunch, because I think, “It’s lunchtime. Maybe they’re busy.” I call again the next day. And again the following week. No one ever answers. So, I think: “Okay. There’s no way I’m going to get an answer.” I take a half-day off and I get in my car, 8 months pregnant, and I head to my clinic. And I wait to speak to the receptionist at the medical clinic. I see other women waiting who are in the exact same situation as me. “I just needed a small change.” “I didn’t need an in-person appointment.” “I just needed to speak to my doctor.” And instead, we all played phone tag. And we had to go there in person.
I added up the time it had taken just to deal with this minor issue. How much gas had I used to get there? How long did it take me? How much time did I have to take off work just for this minor issue? What happened to me is an example of a problem caused by not sharing data. It was up to me, the patient, to be the messenger between my doctor and the hospital, to bring the referral and say: “There are issues with the referral. I need to take care of it.” It’s a symptom of the problem. When data isn’t shared, it’s up to patients to fill in the gaps. And it’s invisible work. It’s time-consuming, frustrating work. For patients who just want to focus on getting better, or for caregivers who have to go through all that red tape, over and over again, to help relatives who are patients. That’s what I was trying to explain in my article. It’s a symptom of a lack of data sharing. And where are we headed?

Alya Niang

And I imagine that at 8 months pregnant, you had a lot of other things to do than waste your time on a tiny correction that could have taken a minute to do without really needing to go anywhere. Jennifer, what do you have to say about that?

Jennifer Zelmer

I understand that it must have been incredibly frustrating. Because, as you said, Flavie, it was a lot of work, for you and for the office, to figure how someone needs to be there in person to sort out something fairly straightforward. On the other side of the coin, I too needed a completely standard lab test a few months ago, and I didn’t have to go see the doctor. My doctor sent me a secure email with the file I needed. I had to print out the file, but still. I took it to the lab centre, and the results were made available to me. I could see them online. After the test was done, I didn’t need to see the doctor again. I could see the results, and they were all completely normal. I got to move on to other things in my life, and so could my doctor. So you can see the difference. And there’s an opportunity now for everyone to have the experience I’ve described. Because it isn’t technology that’s stopping us now. We have a chance to sort this out and speed up progress.

Alya Niang

Exactly. Flavie, when you heard that Ottawa had made this issue a priority, what did you think?

Flavie Laliberté

I thought it was great news, because when you talk to providers, people in the health care system and patients, people often ask what’s getting in the way of progress. And often, it’s legislation on data sharing and funding. So, if the government addressed those 2 issues, it would remove these obstacles, and we could speed up progress. Because the technology is there. The technology is there in the United States, and it’s there in Europe. The providers I spoke to at the e-Health Conference were all ready to implement patient portals, asynchronous communication between health care professionals and electronic referrals. They’re ready. They’re just waiting for the data to be allowed to be shared. So, the fact that the federal government is pushing for that is encouraging. We should see exponential progress in the next 3 years.

Alya Niang

1 of the other interesting points in the federal-provincial agreement is that a large part of what has been proposed is conditional, i.e. the $20 to $25 billion for priority projects, based on what I’ve read. They’re basically saying to the provinces: “We’ll give you the money for these projects, but we expect you to provide the data.” Jennifer, why is the data important?

Jennifer Zelmer

I think that when we set an objective, it’s important to have some metrics so we can see where we’ve made progress and where we still have work to do. And I think that’s why the provinces, territories and the federal government have said, in the bilateral agreements, that it isn’t exactly the same for each jurisdiction because their situations are different. But they’ve said: “We’re going to make progress here, and this is how we’ll measure it and see how we’re advancing.”

Alya Niang

Do you know what kind of data Ottawa is specifically requesting from the provinces and territories that they aren’t currently providing?

Jennifer Zelmer

I think the data varies somewhat from 1 jurisdiction to another because the agreements are specific. They’re bilateral between the federal government and the provinces and territories. But I believe there’s a report that CIHI is in the process of completing with initial data that’s up to date for now. And after that, there will be an opportunity to continue including more indicators and anticipate future trends.

Alya Niang

A number of provinces are now moving toward private health care delivery, toward private clinics. When different data is controlled by a private organization, how do we know whether they’ll be able to properly share information, Jennifer?

Jennifer Zelmer

First, I think it’s important for the data to belong to patients. And if patients have the right to access their data, it doesn’t matter if the organization is private or public. If it’s your services and data, you have the right to access it. After that, if we look closely, there are differences in what we call private health care systems. Are they funded privately or publicly? Are the services delivered private or public? If we look at doctors, for example, they’re mainly private. They have their own private practices, but they’re publicly funded. When there’s public funding, there are conditions that come with it. And with those conditions, they need to provide information. For example, if you went to the doctor, Flavie, they would say: “Flavie had a visit on such and such date, such and such year for such and such service.” And that’s the information we would use afterwards, too. So, I think there are several ways to make sure the necessary data is available first for patients and their care, and then for the delivery of health care services.

Alya Niang

Jennifer, to get back to the main topic, do you think the agreement we’re talking about will lead to better health care for Canadians?

Jennifer Zelmer

Well, I absolutely hope so. Because the objectives are ones that we know are important to Canadians. As you said, Aliya, we all want primary health care that we can access when we need it. We all need to be assured that there’s support for health care professionals, who play a truly essential role in the services we need. These objectives are important to all Canadians, and that’s why I absolutely hope we see some progress.

Alya Niang

Flavie, are you optimistic about what you’re seeing?

Flavie Laliberté

I’m very optimistic. But I still want things to happen more quickly, for change to happen sooner, because all these communication problems and delays are affecting patients right now. And just 1 miscommunication, 1 delay in a diagnosis can mean life or death for someone, a relative or a friend. So, I’m optimistic, but when people say to me, “in 3 to 5 years,” I think, no, we want to see a difference in 6 months to a year. We want access to improve and we want wait times for access to care to decrease.

Alya Niang

It really can just take a minute, or even less, for everything to go south. So, as you just mentioned, communication is very important. To wrap up, Flavia, what do you hope will be different for patients 5 or 10 years from now, once this agreement has been reached?

Flavie Laliberté

I hope that in 5 years, I’ll have access to my medical information, be able to have online consultations with specialists, get prescriptions online, get requests for tests online and communicate with doctors and clinics and hospitals online. I’d also like to have all the automatic benefits you get with apps when you book a massage or a haircut. I’d like to have exactly the same thing when I make an appointment with my doctor: where to go, what time and reminders. Once I’ve seen my doctor, I’d like to get my treatment plan by email so I can remember it, to get reminders and to be able to communicate freely with clinics and physicians. I’d like to improve communication, simple as that.

Alya Niang

That would really make a huge difference to all patients.

Flavie Laliberté

1 last thing I’d like to add is that there should be just 1 place to access all this information. Because I don’t want to have 10 different apps to talk to my pharmacist, my doctor, my clinic and my hospital. I want 1 place where I can access all that information and contact them. That would also help people who have a hard time with technology. Instead of having to go to all these different places, they’d just need to learn how 1 works. It would make things easier for patients and their caregivers.

Jennifer Zelmer

Several years ago, I did a focus group with a group of patient partners. And we asked what was most important to them, and that was the thing they said was most important.

Alya Niang

Great. Thank you, Jennifer. Thank you very much for your time, Jennifer and Flavie. I appreciate having the chance to discuss such an important and urgent topic with you. And I think we should do this podcast again in 5 years to see how funding has evolved and whether we’ve made any progress in these key areas. Thank you again for your participation.

Flavie Laliberté

Thank you, Alya. I enjoyed the conversation.

Jennifer Zelmer

Thank you and talk to you soon.

Alya Niang

All eyes are on this new health care funding agreement when it comes to innovation, flexibility and increased accountability, demonstrating to what degree provinces and territories are delivering timely, high-quality care to patients across Canada. Thank you for listening in. Our executive producer is Jonathan Kuehlein. Special thanks to Avis Favaro, the host of our CIHI podcast in English. To learn more about the Canadian Institute for Health Information, please go to www.cihi.ca. Don’t forget to subscribe to the Health Information Podcast and listen to it on the platform of your choice. I’m Alya Niang. Talk to you next time.