The future role of government series

Inequity still exists in Canada, although there has been progress, when it comes to accessing and receiving health services. Getting the proper care at the right time and place is not a reality for everyone; race, gender, age, disability, location of residence, and/or socio-economic status can affect their ability to access the services they need and the many barriers some face pose a significant threat to their long-term health outcomes.

Such health inequity ultimately costs taxpayers billions of dollars in avoidable spending, costs the economy due to loss in productivity, and, most importantly, costs people their standard of living and even their lives.

Given these losses, the urgency to act is clear. Government needs to redefine its role to better support an effective health system and foster a robust social safety net.

Over the past few months, Deloitte leaders have come together to consider the evolving role of government and bring perspective to the state of this country’s health and social equity. Our collective aspiration for Canada is this: to have equitable access to health and related services for the holistic well-being of all, regardless of location, race, gender, ability, sexual orientation, or other socio-economic factors.

This article is part of Deloitte’s future role of government article series, which examines the trends that are provoking governments to act and seeks to provide Canadian governments with bold ideas to help them address the underlying issues. Read our introductory report, The future role of government: Society is evolving. So must the way it is governed, for more context.

Deloitte also recently published a perspective on what the health care system could look like. To learn more, read Health care reimagined: The future of health in Canada.

Canadians are experiencing challenges accessing care at the time that they need it. This can cause patients to miss a critical treatment window and, therefore, have poor health outcomes. ¹ Some are suffering for a considerable amount of time until an intervention occurs, if it does at all.

The many barriers to the timely delivery of health and social services can pose significant risks to some groups more than others, as social determinants of health (SDOH) constitute 80% of a person’s health outcome. ² Groups such as the elderly, marginalized, racialized, or other disadvantaged populations face inequities that lead to worsened health outcomes. Barriers include:

• Discrimination in trying to access care
• Lack of access to preventive health or social services due to lack of primary care physician or nurse practitioner
• Lack of interoperability between health services and health-related social services, which means care is not continuous and it’s more likely people don’t receive the services they need
• Costs that fall outside universal coverage are out of pocket, which puts some services and even access out of reach for low-income populations:
  • Adjacent costs such as transportation and parking, prescription medication, home care services
  • Costs for preventative care such as services from a physiotherapist, dietician, dentist, fitness trainer, etc.
    
• By national average, 30% of health care is paid for privately— including prescription medication, dental care, and specialty care like home care and allied health care services.
  

The government has great power as well as responsibility to reduce the inequities caused by an unbalanced distribution of health resources. It can use policies, laws, budgets, and innovation to advocate for the reduction of these barriers and set achievable goals to foster equity by delivering quality and accessible care for all.

The current state

We have identified seven trends that require Canadian governments to act: low patient engagement, health and social services divide, urban and rural divide, inequitable health outcomes for Indigenous communities, inequitable access for newcomer communities, imminent staff shortage crisis, and rapidly aging population.

Low patient engagement

People in Canada have little to no access to their health data—whether to obtain their own records or to directly access support and services. This results in low engagement and patient agency in decision-making, which leads to delays in seeking care or disconnects in continuous and integrated care delivery. ³ Low patient engagement can also prevent the system from tailoring services to patients’ unique needs, which is counterproductive and detrimental to their quality of life.

Health and social services divide

The disconnect is growing between health and community-based social services, especially for older adults who have a increased need for health-social service continuity. ⁴ This gap deprives patients of necessary care. To deliver holistic and complete care, Canada needs to build an ecosystem that allows health and social services to serve as one.

Urban and rural divide

A prominent mismatch in access and quality of health services exists between rural and urban communities nationwide, which creates inequities in the health outcomes of the two populations. People living in rural regions can have trouble accessing primary and sometimes critical health services due to resource scarcity or mobility issues or lack of basic infrastructure. ⁵

Inequitable health outcomes for Indigenous communities

Among other inequities in health services, Indigenous communities face discrimination, which is exacerbated by health crises such as the pandemic. ⁶ Many communities are in remote locations with few health resources nearby, and less attention is given to improving health outcomes in these communities than others. ⁷

Inequitable access for newcomer communities

Newcomers face language and cultural barriers in accessing health services. Many live in clusters that may be physically or culturally removed from other communities, and some speak different languages and have information sources that are different from the mainstream media. People living in these communities can have trouble receiving appropriate health services due to factors such as access, discrimination, and systemic racism. ⁸

Imminent health workforce shortage

The traditional health system functions on a foundation of health care professionals and in-person care delivery. But professionals are experiencing burnout, and a large cohort of physicians are due to retire soon. A labour shortage crisis is looming, which will lead to the shutdown of clinics, hospitals, and even emergency departments.

Rapidly aging population

The current health system is not ready to handle the needs of a growing proportion of seniors and their caregivers. Canada’s approach to caring for the aged emphasizes the use of long-term care homes, which was revealed during the pandemic to be a system under severe strain already. Care for the elderly requires an overhaul to rebuild public trust.

Recommendations

To help the federal government address the current state of Canada’s health and social inequities, we’ve developed numerous targeted recommendations. They are as follows: people and leadership; policy and processes; technology; and collaboration.

People and leadership

How can the government alter provincial and territorial governance structures to support a more equitable health and social care system?

1. Incorporate a bottom-up approach to governance: Currently, health care governance in Canada follows a top-down approach, where the federal and provincial and territorial governments set budgets and agendas for municipal governments to follow. This hierarchical structure maintains a power imbalance. ⁹ While there is value in the top-down approach, it is also beneficial to incorporate a bottom-up approach to run in parallel. The federal, provincial, and territorial governments need to set standards, outcomes, and expectations, but since municipal and local governments understand the needs of their communities better, they should have power to decide how funding is allocated. Running the approaches in parallel can help foster a collaborative relationship between municipal governments and the federal or provincial/territorial government, and help better tailor the health and social care delivery systems to communities.

Policy and processes

Which models can government modernize or adopt to become a more equitable health and social service provider? How can government incorporate patient empowerment?

1. Encourage technological integration and innovation: There is a need to shift the health services paradigm toward decision-making that is shared between and informed by clinicians and patients. The current landscape might restrict such an effort, due to the lack of data interoperability among health service providers. The government could position its policies to promote interoperability within and across provinces and territories, which would foster unified data organization and better user access which in turn could increase patient engagement. Supported by technological innovations that help track patient health, this improved engagement could lead to early detection and management of diseases, resulting in better health outcomes.
2. Universal health savings account: Currently, about 30% of health services—such as drugs, dental care, and specialty care (e.g., home care)—are paid for privately. Those costs are not publicly insured because they are considered non-essential. However, they are necessary for the long-term well-being of those many who can’t afford this type of care. A baseline universal health savings account, funded by the government, could act as an allowance to pay out-of-pocket costs for the necessary health care that complements publicly funded care.

Technology

How can government leverage technology to resolve health and well-being disparities caused by the urban and rural divide? How can it be used to promote individual empowerment and create healthier outcomes for people?

1. Digital ecosystem in rural areas: Everyone needs digital equity and literacy skills, particularly those who live in rural and remote areas that are far from well-provisioned health and social services. By leveraging telehealth/telemedicine, such as the 811 health line, the disparity in health services access between rural and urban areas can be reduced. To help underserved communities, provincial, territorial, and municipal governments could consider devoting more resources to rural areas to develop technology strategies, improve digital infrastructures, and educate the public. A digital health ecosystem would promote a future of reduced disparities between urban and rural areas.
2. Digital health credentials: Canadians have limited access to their personal health information and they have to actively follow up the status of any application they make for social services due to protocol and technological limitations. This limited access results in the feeling of powerlessness and frustration, which could discourage people from seeking care and services. But innovations such as digital ID could change that, allowing patients to easily access services, from health care test results and vaccination records to disability payment applications, and obtain real-time updates of pending processes. Digital health ID can open the door to interoperability between services through a single form of identity and ensure privacy while facilitating integrated, easy data access. Such transformative technology services can allow for better quality, security, privacy, and access to health and social services for all people living in Canada.
3. Health data-sharing: Many patients, especially those diagnosed with certain conditions, can monitor their health indicators at home. But even if they notice abnormal readings, they usually only visit their doctor or clinic when a severe problem occurs. Encouraging data interoperability and implementing complete health data-sharing between health services providers and at-home health monitoring technologies could allow health services professionals and patients to follow up on abnormal results promptly. This would allow people to continue executing simple health measurements at home (blood sugar level, heart rate, oxygen saturation, blood test, etc.) while receiving prompt professional follow-up and treatment options if the measurements begin to cause concern.
4. Gamifying health to promote healthier behaviors: With research suggesting that gamifying health can promote healthy behaviors and population health outcomes, ¹⁰ governments could enlist the support of policy and technology tools to help improve public health outcomes—for example, initiatives that encourage insurance discounts for people who accumulate enough “health points” by exercising or eating healthily. There are many examples of digital health tools and applications in both the United States and Europe that gamify and promote health. ¹¹ Inspiration closer to home includes Manulife, in the private sector, which has employed gamification programs to help its group benefits clients stay healthy. ¹² The Canadian government could also look at taking advantage of digital platforms as a tool to incentivize and promote healthy living—empowering people to reach their optimal health.
5. Unified health and social care platform: There is a lack of communication, interoperability, and knowledge-sharing between health care and social care institutions, including community-based organizations. Social care services are sometimes vital to achieving optimal health outcomes, ¹³ so ensuring providers have equitable organizational digital access and creating an all-encompassing platform that patients can use to access health and health-related social care services can help provide continuity in care and improve their health.

Collaboration

How can government collaborate to improve equitable access and outcomes to health and social services for everyone living in Canada?

1. Encourage patient engagement: While government and health services authorities play important roles in delivering quality and individualized care, it’s also important to encourage people to get more involved with their own health journey. It can be challenging for residents to seek some specialized health services due to limited access to their health records, but enabling them to engage more can empower people to seek appropriate care, improve their health outcomes, reduce costs, and increase their satisfaction regardless of their race, ethnicity, and socio-economic status. ¹⁴ The government can play an instrumental role in providing education, encouragement, and technological support. A paradigm shift will create a future where individuals can be active participants—fully informed decision-makers—when it comes to their health and well-being.

Conclusion

If governments across Canada take action in all the areas addressed here, we can achieve a future state where:

• Health equity is the norm and every person receives a high standard of care regardless of their address, community, race, age, gender, wealth, place of birth, and more. Different levels of government have worked together to transform Canada into a place that is internationally recognized for its dedication to health equity.
• A top-down government structure is balanced with bottom-up input that empowers communities and local governments, while united provincial and territorial health authorities deliver consistent, equitable care that fits the needs of local communities.
• The fostering of digital innovation has led to technologies like an interoperable digital ID that enables data-sharing, gamifies healthy lifestyles, creates a rural digital ecosystem, and unifies health and social care services.

Endnotes

Thank you to our key contributors, Rudy Saksena and Sabrina Wang.