Temas de Capa

“The status quo is not good for patients and it’s not good for the health of providers.” – Dr. Kevin Smith

Woman waiting for doctor in hospital
Woman ‘s hand waiting for doctor in hospital.


The consequences of the population growth and the problematic effects of a pandemic have created the perception that the Canadian Health System is in distress.

Health is a major concern of any citizen and 41% of Canadians report encountering many struggles when accessing healthcare services. In this edition, sought to understand the reality lived by patients and providers,

Dr. Kevin Smith - MILENIO STADIUMMilénio Stadium interviewed Dr. Kevin Smith.
Dr. Smith is the President & CEO of University Health Network, Canada’s largest academic health sciences centre, and serves as Chair in the Council of Academic Hospitals of Ontario. With an extended successful career in the public health sector and commitment to education, research and exemplary clinical care, Dr. Smith’s enlightened us on the importance of cooperation between different levels of government and on preparing for a reality that will be experienced years from now to ensure that patients of the future will find the services they need.

Milénio Stadium: What are the main causes for the collapse of Canada’s healthcare system, once considered one of the best in the world?
Kevin Smith: I don’t think our health system has collapsed, but it is very strained, perhaps as strained as it has ever been in our history. We continue to undertake a great deal of care of our patients every day. Most of which is very well done and highly satisfying. I think what is contributing to this perception of significant challenge is almost exclusively access. We have a growing population and aging society – older people consume more health services – with many new treatments that are successful. People that once would not have survived with certain illnesses, now survive, and live for many years. That does mean that other diseases, recurrent of the original disease, come up. Last but not least, the principal reason that I think drove people to this perception of collapse is the shortage of health care providers and those who are able to support them.

MS: There is some reluctance in the partnership between public and private, due to the possibility of creating a lucrative market and lead health workers to private institutions. Do you believe that resorting to the private sector will bring benefits or is it just a temporary fix?
KS: I don’t think that is as simple as involving the private sector or don’t. I think it’s about, if we plan to involve the private sector further – because they are already involved – how? Recall that about 30% of what we do in health care is already in the private sector – eyecare, much of our physiotherapy, drugs, and physicians are privately incorporated. For me, the most important question is, how do we preserve universal access? Which means everyone, regardless of ability to pay, gets the same high standard of care. I’m predisposed to believe that partnerships with not-for profit private sector organizations bear greater fruit and see that investments turns into more care or more scholarships in the case of research-intensive environment like ours.
When I look at the Scandinavian countries like Sweden and Denmark, the private sector has found a place to be involved, it has not decimated the public system or access. I think the worst place to look for how meaningful the private sector role could evolve is the United States and I think that, unfortunately, far too many people equate the US private sector medicine to what may be explored in Canada. I reject that and say that, if we are going to explore further partnerships with the private sector it will look more like the north of Europe.
I hear from almost everyone, patients and providers, and something has got to give, the status quo is not good for patients and it’s not good for the health of providers. We need to look for innovations and in bringing all those parties to the table. In my own personal view, if we look at what are the unintended consequences that we fear with some of the partnerships that have been discussed between public and private collaborations, we can put guardrails and parameters around that, experiment with that and take to scale those things that make sense and that don’t drive up the cost without better access and better outcomes.

MS: According to a study from the Angus Reid Institute, 38% of Canadians don’t believe the federal and provincial government will find a solution for the health care system. These two levels of government will hold a meeting next week to discuss the Canada Health Transfer, in your opinion, would a bigger contribution cause a positive impact or are the issues deeper than financial resources?
KS: There needs to be a social contract between the various levels of government – not just provincial and federal government, but also municipal and city governments because they are crucial to the funding and implementation of things like public health and long-term care. All levels of government must work together. Indisputably, we need to revisit what is the balance of investment between the various levels of government. And to be honest, both as a taxpayer and as a leader in healthcare, it’s all one pot when it comes to my tax dollars. As a citizen, I don’t go and look ‘who taxed me for that’, I look at the overall I’m paying. My expectation is that governments will work out and declare what is the basket of services that we will fund, how will we share that funding and make that transparent to Canadians. If there are things that the government is unable, unwilling or don’t feel they are clinical indicated and that aren’t being funded that Canadians want, then I think we need to address how they will pursue those. Is it through insurance schemes, benefit programs or through direct pay?
Unquestionably, our patients and our consumers are ahead of us. They want a more consumer-centric and positive patient experience. And clearly, they want better access, better communications, and better follow-up.
Thus, the investment piece is important, but it’s also important to sit down with levels of government or funders and be remindful of two things – funders don’t deliver care, that’s what provider organizations like hospitals and physicians do. So, we need to discuss what is our standard of care, how will we deliver that care, how will both providers and consumers get better data to evaluate the quality of care they are receiving.
Consumerism and the confident of the patient should be much more prominent in the evolution of our system.

MS: It is estimated that in 10 years, the city of Toronto will have a population growth of 15%, seeing the doubling of those over 65 years of age. Considering that hospitals from their conception to their construction can take up to a decade to start serving the population, how should we treat this healthcare challenge?
KS: It’s not something that will happen all the sudden. Every year we get one year older, every year we see about 500,000 new Canadians, but we absolutely need to be attentive to that, especially in places like Toronto. I work at University Health Network, Canada’s largest hospital, and we would likely need to double in size to keep pace with population growth and the growth of chronic diseases and recurrent diseases like cancer, heart diseases and other illnesses. We absolutely need to think about that, but we also need to think about where, how and who delivers care. I don’t think most of us want to go to hospitals, or long-term care or chronic care. We want services in our home. Thus, I think while we are projecting, we need to also challenge ourselves – can we do more to keep people in their homes and reduce the length of stay in acute environments?
Around the world, we are seeing remarkable technologies emerge. I think that Canada and Ontario have said they would like to be a Digital leader in public health services. If that is true, in addition to the capital renew and growth of hospitals, we also need investment in new technology, innovation and digital health. Therefore, we don’t build things that are going to be antiquated and that don’t meet the needs of the future population.

Inês Carpinteiro/MS

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