Ontario’s primary care fix is pure politics, not problem-solving
The Fraser Institute endorses Ontario’s new primary care plan, which should tell you everything.
In a recent commentary, the conservative think tank commended Jane Philpott “for identifying the Netherlands as a model for reform.” Those familiar with The Fraser Institute know their sponsor list is a who’s who of moneyed libertarian ideologues. It includes the Koch Foundation and ExxonMobil. When the Fraser Institute joins forces with politicians to support a vision of healthcare, be wary.
Our well-known state of crisis has been decades in the making. Bipartisan defunding, escalating practice costs, scarce human resources, oppressive administrative burden, and patients that are much more complex — it’s no wonder primary care is in tatters.
6.5 million Canadians don’t have access to a family doctor. Of those, 2.5 million live in Ontario.
Primary care is the base upon which Medicare rests. Without it, the system defaults to a reactive mode of care. This comes with a litany of risks as articulated in my book. As small, unaddressed health issues turn into irreversible medical problems, our healthcare costs rise sharply, and our society becomes sicker.
In 2024, Ontario’s Progressive Conservative government announced that former Liberal Health Minister, Dr. Jane Philpott, would lead a new primary health care action team. The appointment linked Philpott to a Premier notorious for cutting health spending, pushing privatization, and targeting the province’s nurses with austerity measures (Bill 124).
Since partnering with Philpott, Ford has made fixing primary care a centrepiece of his re-election bid.
After Philpott’s appointment, the government announced $1.8 B in spending over four years to connect every Ontarian to primary care. This announcement came the same week Ford declared he would call an early election.
The plan includes geographically assigning Ontario residents to care teams based on their postal codes. It is a design modelled after countries such as Denmark and the Netherlands, where primary care access rates average 95%. While most agree Canada’s current system is in peril, will shoehorning the Dutch model into Ontario actually work?
Dutch citizens purchase mandatory health insurance from private insurers. They may be fined if they do not. They must pay a deductible of $693.00 before receiving insurance contributions. Insurance premiums can also be levied directly from their income and Dutch citizens over the age of 18 must purchase their own insurance.
In Ontario, provincial and federal taxes cover most costs. Anything not covered by Medicare (dental, physiotherapy services etc.) is obtained via private insurance and/or out-of-pocket payment. There is no age limit on insurance coverage.
Little has been written about how the Dutch system could be sustained in Canada, let alone Ontario. There’s scant discourse about what the true costs would be, or the healthcare challenges the Netherlands is currently experiencing.
With entirely different cultures, governments, geography, demographics, and systems of health funding, Ford and Philpott’s plan is built on an apples-to-oranges comparison.
The government says it needs a $1.8-billion plan to address the family doctor shortage. The Ontario Medical Association says the province is short 3,500 doctors. Even if 3,500 doctors could actually be recruited, the average salary of family doctors alone ($ 242,795) would amount to close to $1 B per year. And this doesn’t capture the province’s shortage of 26,000 Nurses. The numbers don’t add up.
Conspicuous by its absence, is any mention of the ongoing issues plaguing the Dutch system. Deductibles continue to rise, and patients feel invisible in busy primary care offices.
Dutch citizens refer to their system as the Paracetamol (Tylenol) system, where Tylenol is liberally administered for most ailments. Three quarters of Dutch GPs experience increased workloads and burnout, including evening, night, and weekend services that are required on top of their regular work. Health insurers add significant administrative burden.
Canada’s primary care systems need to be rebuilt. But this predicament requires solutions within a Canadian context. Superimposing the Dutch system upon Canada’s most populous province obfuscates its shortcomings. Family practices won’t survive with mandated patients. The infrastructure and human resources do not exist to implement Philpott’s plan, unless the plan is to replace doctors with nurse practitioners.
In battle, a tank occupies strategic cover for the approaching squadron. And that is precisely what the Fraser Institute think tank is doing with its endorsement of Ontario’s plan — providing cover for Ford’s neoliberal platoon.
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Catherine MacNeil is the author of Dying to be Seen: The Race to Save Medicare in Canada.