What Ontario's healthcare plan means for cancer care

Last week, the Ontario government outlined its plan to perform some surgeries in private clinics, including cataract, hip, and knee surgeries, along with MRIs and other scans. It should be noted that Premier Ford has announced that Ontarians will pay for services under its new plan with their OHIP card, not their credit card, and that other models for reducing surgical backlogs also exist. For example, Dr. Bob Bell, former CEO of UHN and a former Deputy Minister of Health in Ontario, strongly favours performing certain surgeries outside of hospitals in purpose-built community surgical facilities, run by and governed by non-profit hospitals, not private business.

What does the Ontario government’s plan to perform some surgeries in private clinics mean for cancer?

For some, the use of the word "private" anywhere near the word "healthcare" immediately conjures images of the American healthcare system – and American healthcare is expensive! Healthcare expenditures in the US have almost doubled from $1.9 trillion in 2000 to $3.8 trillion in 2019, with spending on cancer care in the US following a similar pattern, surpassing $200 billion in 2020.?These expenses impose a substantial burden on patients, with annual out-of-pocket spending on cancer care estimated at $16 billion in the US.?Furthermore, an estimated 12% to 62% of American cancer survivors report being in debt because of their treatment, according to authors of a major study published last year in JAMA Health Forum that compared cancer-related spending and mortality rates in the US versus 21 high-income countries.

The factors associated with the high cost of cancer care south of the border must be considered. Cancer drug expenditures account for 37% of privately insured US cancer expenditures. Prices for the same medications are higher in the US and cancer drugs frequently increase in price after their initial launch. This phenomenon stems from the inability of Medicare to negotiate pricing, along with state laws mandating insurers to cover all approved cancer drugs regardless of cost.

Additionally, end-of-life care is resource-intensive in the US – within the last 6 months of life, Americans with cancer are admitted to the ICU at twice the rate of other countries and are more likely to receive chemotherapy. Compounding this issue, low-risk tumors such as early-stage prostate cancers, are often subject to intervention in the US, according to the study’s authors, despite evidence that many of these lesions are unlikely to cause harm if left untreated. Finally, doctors in the US are more likely to be sued than in Canada and many other countries.

The substantial American expenditure in cancer care raises the question of its value: Are the high expenditures on cancer care in the US accompanied by lower cancer mortality rates, particularly in comparison with other high-income countries? The conclusion from the study: although the US has the highest per capita spending on cancer care, after adjusting for varying smoking rates across countries, the US cancer mortality rate is comparable with that of the median high-income country in the study!

We shouldn’t be smug about these findings though. Canadians, on average, wait longer to get care than patients in similar countries. For example, in 2016, only 43% of Canadians who needed care were able to book a same day or next day appointment, compared to an average of 57% across other countries; and among twenty OECD countries, Canada tied with Norway as having the longest wait times to be seen by a specialist for a non-emergency in 2019 (see Peterson KKF Health System Tracker under Access and Affordability).

Additionally, while the average life expectancy for Canadians is higher than Americans (81.7 years for females and 76.6 years for males in the US, compared to 84.6 and 81.2 years in Canada), our global ranking is dropping. From 1985-1995, Canada ranked 7th in the world in average life expectancy. By 1995-2005, Canada had dropped to 10th place, by 2005-2015, it was 13th, and by 2020, it was 16th. By 2040, Canadian life expectancy is projected to drop to 27th in the world. It is little cause for celebration that Canada is still much better off than the US, where average life expectancy currently ranks 46th in the world. This is one of the reasons why conquering cancer in support of the UHN Vision of A Healthier World is so important, and so urgent.

In the meantime, we might consider that there are reasons to admire, as well as to be frustrated by, both the American and Canadian healthcare systems, including that it’s misleading to say one system is “private” and the other is “public”. The reality is the US government now pays for nearly 50% of healthcare spending, an increase driven by Baby Boomers shifting into Medicare, and large portions of the Canadian universal healthcare system have always been delivered by private entities – from doctors to pharmacies, which administered many free COVID-19 vaccines.

But when comparing the two systems, Canadians only get what they pay for, and Americans pay far too much for what they get, according to Dr. David J. Stewart, a former medical oncologist from MD Anderson and Professor of Medicine at the University of Ottawa. In 2019, 16.8% of gross domestic product (GDP) was spent on healthcare in the US versus 10.5% in Canada, with an average of $10,966 spent on each American versus $5,418 on each Canadian. The US has by far the most expensive healthcare system in the world, while in 2019, Canada ranked 11th out of 36 OECD countries. In short, Dr. Stewart believes that the American healthcare system particularly fails under-insured younger patients, the poor, and minorities, while the Canadian system particularly fails older patients and many equity-seeking groups, who suffer and die as they wait too long for “free”, but hard-to-access therapies.

Of course, we’ll have to wait to see the effects of the Ontario government’s plan to reduce wait times for patients requiring cataract, knee, or hip surgery, some of whom are cancer patients, as well as the effects of the new plan on all cancer patients once more diagnostic procedures are available through private clinics. In the meantime, as recently as 1991, 215 people out of every 100,000 were dying from cancer every day; fast forward to 2019, and that number has dropped to 146, according to the American Cancer Society. (Rates are similar in Canada). As our healthcare system evolves and as we celebrate Lunar New Year, we’ll continue to raise even more money for The Princess Margaret, knowing our importance as one of the top 5 cancer research centres in the world and the importance of research to progress for cancer patients everywhere – regardless of the type of healthcare system.

Gong hei fat choy! 恭喜发财!

Best,

Miyo

Event News

• Get ready for World Cancer Day 2023! On Friday, Feb. 3rd, we’ll be hosting a spinning event at Princess Margaret Cancer Centre with our Ride to Conquer Cancer team. Come check it out. For more information on World Cancer Day and its theme, Close the Care Gap, check out this moving video here.

We’re partnering with The Ottawa Hospital and Gray Oncology Solutions to build radiation therapy schedules that better manager patient wait times – the first of its kind in Ontario! See the article here.