Navigating Ontario's Underfunded and Dysfunctional Healthcare System:

A Personal Tale

Reading time: 5 minutes

punditman says…

All bureaucracies have inefficiencies —  ripe pickings for right-wing politicians. When a privatization-obsessed government cuts enough public spending in key sectors, systemic weaknesses are exposed, people get frustrated, and they turn their anger back on those very services.

While the origins of Ontario’s health care woes predate the pandemic and previous Liberal governments also underfunded the system, Premier Doug Ford's Conservatives have managed the file for over five years now. Below is a personal story highlighting the dysfunctionality of Ontario’s underfinanced, deficient health care system.

For several years I’ve endured a stubborn, hindering condition that seemingly defies standard clinical analysis and includes regular debilitating pain, accompanied by sleeplessness and brain fog. This is not a “woe is me plea” as there are always others suffering far more. Rather, the point is to show how easy it is to become both baffled and frustrated while traversing a system under constant strain and poised to worsen further.

I don't have a doctor (he retired) but I do have a nurse practitioner (NP) at a  Community Health Centre (CHC), my primary care provider. There are currently about 120 CHCs across Canada. This model — whose exponents emphasize is more efficient and patient oriented — includes a team-based approach of front-line caregivers. It all seemed so promising back in 1988.

For the fourth time, it was recommended I see the same Ear, Nose and Throat (ENT) specialist. Meanwhile an MRI had revealed “nothing going on inside my head” — a great relief! — for which others would concur, I chuckled. Surgery has been ruled out.

I was under the impression that a “referral” still means primary care offices set up specialist appointments and specialists, in turn, report their findings and recommendations back to primary care offices.

Though I’d been told by one near and dear that this isn’t necessarily the case anymore — notwithstanding my aforementioned empty-headedness — it seems old habits die hard.

Communication Breakdown

Aware of how stretched the system is, I waited a reasonable amount of time for my appointment, but heard nothing. Upon calling my primary care office, I learned that apparently I was the one who was supposed to have set up the specialist appointment. Was that because I’d been there before?

After giving up trying on the phone, I went in-person to set up the ENT appointment. When the time came, the ENT concluded I should've been sent to a neurologist, adding that he couldn’t recommend anyone local.

Again I waited a couple of weeks and again heard nothing. (By now you may sense a trend — including my inability to spot it).

Again I called my primary care office and explained the situation. The receptionist asked who was doing the referral. I had no clue. In any case, they still hadn't received the ENT’s notes.

At that point, I said I was stating right then and there that the ENT was simply going to recommend I see a neurologist. Was that not enough to move things along? No, the receptionist explained, my NP will want to see the ENT's notes, but she’ll "fax" over a request. (What’s with this long-term fetish for 1980s tech? Is there still no encrypted digital technology on hand to drag the medical and legal sectors into the 21st century?). I digress.

I was told it should take just a few days for them to hear back.

Three more weeks pass, again nothing — there's that trend again. Again I called my primary care office, and again the receptionist said they hadn't received the ENT’s notes. After I pondered why I’m doing all this administrative work, she said it was it was up to me if I wanted to contact the ENT’s office again. She also asked if I wanted to make another appointment with my NP. (Was there any point if we are just waiting on the ENT's notes?). You may sense another trend: redundancy.

Sensing my disappointment, the receptionist offered to fax the request again. One wonders why she couldn’t simply phone and ask what happened to the last request.

Purgatory. 

I'm sure my experience is not unique. Messages are getting bottled-necked between medical offices. Administration work essential to moving patients through the system is not getting done. 

I get that we have to be our own health advocates in this over burdened, underfunded, pandemic-ruined health care system — nothing new there. But now there's a Kafkaesque twist: we're also expected to be carrier pigeons for a broken system in the hope that we can get out of limbo.

The Cost of Privatization and the Need for Systemic Reform and Sustainable Solutions

Across Canada, health care systems are faltering badly. In Ontario, Premier Ford’s Bill 60 farms out surgeries and diagnostic procedures by funnelling tax dollars to investor-led private clinics. It should be noted there’s a difference between privately delivered, publicly paid for health care (e.g. many doctors’ offices) versus private for-profit health care that lends itself to extra-billing and “upselling” patients. Though still covered under OHIP, critics warn that Bill 60 could lead to a mass exodus of staff seeking better pay and working conditions in the private sector.

This is not to say that simply throwing money at the system is a panacea. Top-heavy bureaucracies are a signal that funds should be spent wisely. And no health delivery model will improve outcomes if the supply of medical professionals continues to be constrained.

But Bill 60 will not solve these problems, not by draining resources away from public hospitals and further weakening a system already beset by chronic neglect, underfunding and massive staff shortages. To make matters worse, the Ford government plans to cut capacity relative to rising demographic need.

Meanwhile, anecdotal stories such as mine abound, along with rising cynicism.

An older fella who I sometimes bump into at the coffee shop, and who happens to suffer from a similar malady, had this to say about our once vaunted health care system: "These days, once you're over seventy-five, they just want to 'off you' anyway." He was only half joking.

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