An apple a day: The business of health care in Saskatchewan

In July 2022 I had a life changing experience: the birth of my daughter. I believe my wife and I had a typical Saskatchewan birthing experience. While obviously this event changed our lives in unimaginable ways, the birth of our daughter was thankfully without incident.

We arrived at the hospital practically on the due date. We were ushered through the intake area, offered medical care by extremely professional and caring people. We moved seamlessly through the labour unit and then into the mother infant unit where we spent 24 hours under the careful observation of trained professionals. We received the medicine, expertise and infrastructure that we needed to ensure a safe delivery. An epidural, antibiotics, bandages, dressings, blankets, pillows, pain medication, careful monitoring, a two-night stay with simple meals for my wife and a private bathroom. There were a battery of tests for hearing, vision, oxygen levels, iron levels, assistance filling out forms to prove our daughter’s existence to others–and even a course on how to bathe, change and feed the child.

We left the hospital under the careful watch of medical professionals whose final task was to ensure our new infant was strapped properly into her car seat. The total out of pocket paid for this 48-hour hospital experience was $12 paid to the parking attendant on my way out. We won’t even get into the following 12 months where my wife was able to spend critical time with our daughter while on paid maternity leave–suffice to say I was grateful for our Canadian health care.

Following our amazing experience in the hospital we had additional follow-ups from nursing professionals who checked in on us in our home to ensure the baby was healthy and answered any questions we had about her health. I will forever be grateful to the Saskatchewan Health Authority (SHA) staff, doctors and nurses of the Regina General Hospital and especially those who work in the maternity ward. But something struck me when I got home, something that I hadn’t noticed while sleeping in “that chair” next to my wife and brand-new daughter. It occurred to me when I got home that the faces that I had seen when we arrived–the faces I had seen throughout our stay–and the faces I was saying goodbye to on our way out the door . . . were largely all the same faces.

On reflection, the hours being put in by these medical professionals was ridiculous. We restrict the length of time that professional truck drivers can be on the road, and the amount of time that airline pilots can be in the seat because we know that human beings do not perform at their best when they are tired. And yet our health care system is designed in a way that has individuals working seemingly endless hours trying to deliver lifesaving services.

In the weeks that followed the birth of my daughter I started asking questions about how Saskatchewan’s health care system had gotten to where it was and what steps could and should be taken to protect this incredible Institution and the people that have kept it moving forward through extraordinary times.

Tommy Douglas is widely known as the father of medicare. The former Saskatchewan premier helped bring medical reform and universal health care to the province. But the father of medicare also brought warnings of what could happen if medicare wasn’t properly administered. With an eerie sense of foreboding, you can watch a clip from 1979 (now conveniently posted on YouTube) where the aging politician outlines the problems beginning to build in a system that rewards volume-based outcomes instead of health-based outcomes.

There were cracks in our system then that were apparent to anyone willing to look. Forty years later, Covid smashed those cracks wide open.

Unrelated to the father of medicare, Tom Douglass, CEO of Lumeca, is now one of many people trying to take Saskatchewan in particular, and Canada in general, into a new era of health care for everyone.

Lumeca is working to provide some relief to the strained system with the use of telemedicine. The secure transfer of information, the ability for interaction via video call from medical professionals and their potential patients, helping provide context to emergency calls that will better support triage efforts during emergencies.

“I want to say that technology is not going to fix our problems, but it’s going to enable us to deliver care better. I mean, we need a paradigm shift—in all honesty, we’ve got some big problems. We’ve got provider shortages; we’ve got an aging population with an increase in chronic diseases. Diabetes, for example, has become less deadly, the mortality has gone down, but the prevalence is still going up. Our compensation model is broken too,” explains Douglass. “The way we’re set up to compensate care providers is based on throughput, not health . . . and so we have to look at and rethink compensation, too.”

Douglass understands there’s no panacea, but he does feel there’s something core that could assist.
“It’s called healthcare teams, and it’s been advocated by the Canadian Medical Association for a long time,” he explains. “The reality of the system right now is that everyone is treading water. We’re running our nurses into the ground, working 12-hour shifts when we know eight-hour shifts works better. There are some things we could fix quickly under the right conditions, and others that are going to take time because getting the knowledge and expertise to help patients with serious illness or injury takes time.”

Joelynn Radbourne understands that a full solution will take time, but as a front-line worker herself she also knows that time is something we are running out of. “The health care system has been crumbling for about a decade. We were this car teetering on the edge of a cliff, and Covid-19 basically pushed it off the edge.”

“Covid-19 identified the gaps in our current healthcare model and the delivery of that model to Canadian and Saskatchewan residents. Essentially, we had these small little cracks in the healthcare model that became huge craters when Covid hit. So, the current model of medicare is just not working. The healthcare system is not working. The delivery and access to care in a timely fashion is getting worse and worse,” says Radbourne. She goes on to explain that large numbers of patients are not able to see primary care practitioners on the same day or the next day when they needed care. What we can also see is that these numbers are different from other countries around the world who have a model more based on health outcomes. While it’s hard to compare Saskatchewan (with 1,000,000 people and a vast land mass) to countries with deep populations and smaller distances between populated areas, it does show that changes could be made to help.

What is one quick fix for a massive problem like this that requires years to train more doctors? Well with the opening of her clinic, Vaida Health and Wellness, Radbourne has found one solution to bridge the gap. “We allow advanced practice nurses to see patients for common ailments such as things like flues cough, colds, bladder infections, things that don’t need to be seen by a nurse practitioner such as myself or a doctor or we allow nurse practitioners to have their own clinics.”

The restriction on this is currently legislation–these practitioners have the skills and abilities to do the work but not the legal ability to set up shop and bill in the same manner. A legislation change could free up a lot more bodies to help relieve the pressure on the health care system. Radbourne expands, “being able to bill the ministry the same way physicians do–I currently can’t do that. So I work in a private practice centre instead and therefore bill my patients or their third party insurances.” The private practice allows her to build team-based practice models, where patients have access to multiple disciplines, so that the medical providers work within all of their own scopes, but there’s increased access and a holistic care solution.

How do we fix a deeply fissured system while we continue to offer world leading services in a widespread, thinly populated province? It is no small thing to call for a paradigm shift in an industry that employs more than 40,000 people. After all, we are the home of medicare.

But the problems our health care industry is facing are going to be dealt with soon, drastically, one way or another. We can initiate change and once again be the birthplace of modern health care, or we can wait to sift through the rubble of the old system when it collapses. Technology, legislation, and information are all going to be needed to tackle this problem before the major implosion takes place.