While total health care spending has increased over the last 20 years, Canadian capital investment in health infrastructure has fluctuated, with a noted decline in recent years.1 Healthcare institutions across the country must regularly dip into fundsBest estimates of deferred maintenance in the healthcare sector come from a study conducted in 2015 and was already at a staggering $15.4 to $28 billion at that time2 allocated to updating infrastructure to provide patient care.
This necessity effectively mortgages the future of Canadian healthcare infrastructure, leaving it woefully outdated, environmentally unsound, and at risk for climate change related damage. Most importantly, a lack of investment in healthcare infrastructure undermines patient care and poses potential risks to patient safetyThe 2021 cyberattack against the Newfoundland and Labrador healthcare system resulted in a complete shutdown of the patient booking and health information portals, resulting in thousands of appointments and procedures getting delayed, including chemotherapy treatments..
Federal-provincial-territorial jurisdictional issues are often cited as a major impediment to direct federal investment in healthcare infrastructure and healthcare more broadly. However, the public dismisses these concerns. Polling conducted by Abacus Data for HealthCareCAN in late 2020 shows that the majority of those polled do not care about political jurisdictions and want all levels of government to work together to improve healthcare.
What actions can Canada take to support the health system in addressing its infrastructure challenges?
Ensure infrastructure funding reaches the health sector by providing healthcare organizations, such as hospitals, research institutes, health authorities, and long-term care facilities with direct and equal access to federal infrastructure funding.
Increase capital investments in healthcare to a minimum of 0.6 percent of gross domestic product (GDP) (approximately $12.5B) to better align with Canada’s Organsiation for Economic Co-operation and Development (OECD) counterparts.
Support the expansion of virtual care and digital health.
Improve information technology and digital infrastructure across the health system.
Bolster the healthcare sector’s cybersecurity capabilities through investments, programs and standards.
Continue enhancing broadband services in rural and remote areas to ensure everyone has access to and the ability to use virtual care and digital health tools.
Work with provincial and territorial counterparts to ensure administrative and regulatory policies are in place to support virtual care.
Why must Canada better support the health system in addressing its infrastructure challenges?
The COVID-19 pandemic highlighted the serious challenges facing Canada’s health infrastructure.
In long-term care, multiple-bed rooms did not allow for proper implementation of infection prevention and control protocols, and older facilities fared far worseIn Ontario, the Office of the Auditor General’s blistering report identified that overcrowding and a lack of room for isolation made it nearly impossible to observe proper infection control protocols and concluded infrastructure was a major contributing factor to the high death toll.3 in terms of cases and deaths.
In acute care, hospitals often could not keep up with the volume of COVID-19 patients because they lacked the space and equipment needed to treat them.
In primary and specialty care, providers quickly shifted to providing virtual services, but often had to implement digital platforms and tools as they went. Canada’s digital health systems, fragmented across jurisdictions, made it difficult to collect comprehensive data on the association between infection rates and socio-economic factors, geographic location, and age and hindered the sharing of critical patient information across organizations.
Further, the combination of legacy technology, remote work without robust cyber security measures, and highly sensitive information has made healthcare a highly lucrative targetIn 2020 there was an increase of over 45% in cyberattacks, the largest increase by sector. for cyber criminals.
And finally, a lack of health-related manufacturing infrastructure and capabilities meant Canada could not produce much-needed personal protective equipment, drugs, and vaccines domestically.
Providing healthcare organizations with direct and equal access to existing infrastructure funding programs will:
Ensure that Canada’s healthcare organizations (hospitals, research institutes, health authorities, and long-term care homes) are less reliant on funding that flows to the provinces and territories, and possibly further to municipalitieswho often overlook the need to invest in health facilities, thinking that these vital public buildings fall within the purview of health ministries and will be addressed through healthcare funding..
Increasing investments in health system infrastructure will:
Reduce wait-times.Canada’s average bed occupancy rate between 2000 and 2015 was 91.6%, which far surpasses the average of 75.7% among 27 OECD countries.
Improve patient outcomes.
Provide critically needed surge capacity in the system.
Strengthen the resilience, sustainability and equity of the health system.
Position Canada’s economy for growth and prosperity by creating jobs.
Help Canada reach its net-zero emissions target.
Supporting the expansion of virtual care and digital health will:
Allow practitioners and researchers to provide better care for patients.
Facilitate research, treatments, and better collaboration.
Significantly reduce CO2 emissions.
Improving information technology and digital infrastructure across the health system will:
Reduce the lag in real-time national health data and better align Canada’s capabilities with other countries.
Break down barriers to patient care for patients transferred between different institutions, care settings, or provinces/territories.
Ensure patients can access their own medical information, and healthcare providers can easily access a patient’s medical history to provide the best treatment possible.
Allow researchers to leverage health data across institutions and jurisdictions.
Bolstering the healthcare sector’s cybersecurity capabilities through investments, programs and standards will:
Help address the rise in cyberattacks on the Canadian healthcare system.
Allow healthcare organizations to assess where they currently rate in terms of cyber resilience and benchmark their progress.
Allow healthcare organizations to develop a mature understanding of their current position and to make the investments necessary to improve it.
Reduce the frequency of cyberattacks brought on by human errors by helping healthcare organizations to invest in educating healthcare personnel about cybersecurity and good cyber hygiene.
Continuing to enhance broadband services in rural and remote areas will:
Improve access to healthcare services across jurisdictions for patients traveling out of province, beyond just emergency care servicesCurrently, the Canada Health Act allows for healthcare coverage for people away from their home province or territory through the portability criterion. While this seems like it would enable greater virtual care options, in reality the portability criterion is limited to only covering emergency care for people temporarily in another province or territory..
Working with provincial and territorial counterparts to ensure administrative and regulatory policies are in place to support virtual care will:
Help to break down the current fee structure barrier that requires both patient and provider to be in the same jurisdiction, hindering access to health care services.
Help to realize the true potential of virtual care, particularly in remote areas that would truly benefit from greater access to medical care and innovative ways of delivering care.
Annual capital expenditure on health as % of GDP (2015‑2019) by type of asset (click image to expand)