Reaping from Public Health ⚰️
Deliberate attacks on public healthcare to justify privatization. (aka. openly embezzling public funds)
Photo by Karolina Grabowska/ Pexels.com
In the past year, I had a lot of trouble accessing the universal health care in Ontario like the other millions of Canadians, because I couldn’t find a family doctor. There are certainly walk-in clinics and public hospitals everywhere, but no one would go to an emergency room when they are not inflicted with an acute illness or seriously injured; regular body checks and blood work can’t be serviced by these essential services.
Coincidentally, after the Doug Ford government announced the policy to expand the numbers and range of surgeries to be done in “community clinics”, a private clinic I had been calling multiple times suddenly started accepting new patients. Getting onto the patient list may have been a result of luck, but I was finally able to obtain the requisition form to get my blood test at a laboratory in another privately run health facility.
It appears that the Ontario government is making a positive move here, but it’s too early to celebrate. What Ontario has been facing in the healthcare system is more tangled and complicated than it appears. The new plan unveiled by Ontario’s Premier in mid-January is not only not going to solve the real problem behind the healthcare crisis but will ultimately add insult to injury and worsen the overall problem.
A disruptive “innovation”
On January 16th, 2023, the Ontario Government released a plan with permanent legislative changes that will allow private health facilities to perform more surgeries and invest more than 18 million Canadian dollars in existing community surgical and diagnostic centers to cover more medical procedural care such as MRI and CT scans. If the legislation is passed next month, the government will further expand non-urgent, low-risk, and minimally invasive procedures to these community clinics, where 97% of them are for-profit health facilities.
In the lenses of the governor, partnering with private healthcare providers is a “bold, innovative and creative” solution to ease overwhelmed pediatric hospitals and surgery backlogs. However, the further exacerbation of the healthcare worker shortage in the healthcare system which is already over capacity was overlooked.
The shortage of doctors and nurses has been dominating the national conversation in Canada. We may find ourselves feeling frustrated with the doctors and nurses who are burnt out by the pandemic, but imagine working in a high-stress and resource-constraint environment, and you are only being paid a pittance. In 2019, the Ontario government passed Bill 124: Protecting a Sustainable Public Sector for Future Generations Act, 2019 to limit nurses’ and other public-sector workers’ salary rate increase to 1% for each 12-month period of 3 consecutive years (known as “the moderation period”).
By giving private clinics a bigger role in carrying out more surgeries, more healthcare workers will be needed in these for-profit health facilities. Their business owners could simply offer a higher wage to pull doctors and nurses away from the public hospital system. Eventually, this new policy is not only going to help shorten our wait time but become a new contributing factor in worsening the hospital staffing crisis.
In February 2023, the government will introduce the new “as of right” rules to allow healthcare workers from outside of the province to work in Ontario without “bureaucratic red tape”, to increase staffing levels on a short-term basis. As Premier Ford said: “We welcome you with open arms. You don’t need to go through any bureaucratic red tape. You arrive here with your credentials, we’ll immediately find [work] for you, and you’ll have a great lifestyle when you arrive here in Ontario.”. This policy was flawed as nurses will come to the province unless competitive compensation is offered in Ontario.
The Progressive Conservative government could have done better by scrapping the controversial wage restraint legislation already, and spending much more in our public hospitals with a $2.1 billion budgetary surplus in 2021, but they continue to deliberately attack our healthcare system with a more profoundly surface-level solution instead.
More options or fewer?
If cutting surgery backlogs is the only goal, then privatizing the delivery aspect of some healthcare services could work, because some surgeries could be performed efficiently outside a hospital setting without sacrificing the quality of care. However, when a private clinic is paid $100 to $150 more per cataract surgery by the Ministry of Health than a publicly funded hospital would for the same procedure, such privatization does not make much sense to me, because we are just openly embezzling public funds for businesses.
The government emphasized that all surgeries outsourced to private clinics will be covered for patients under Ontario Health Insurance Plan (OHIP), but concerns over patients being upsold for services not covered by OHIP continue to soar. As Ontario Health Minister Sylvia Jones confirmed that the province would allow private clinics to provide more “patient options”, the concern is no longer just a fear but a reality. In fact, it is already happening in public hospitals when patients are offered to pay extra out of their own pockets or with their private insurance for a private room. By further privatizing public healthcare, the chances of patients paying out of their own pockets or at least with private insurance increases substantially.
Data from the Canadian Institute of Health Information, this move alone could provide over $500 million in annual profits for private health clinics. As we ramp up the number of surgeries done in these for-profit clinics, the government will be essentially funnelling our taxpayer dollars into the pocket of these business owners.
At the end of the day, these private clinics are businesses with the core purpose of making money from those who are in need of medical care. Patients may be recommended by the healthcare professionals in the clinics to get a pair of premium glasses after cataract surgery, or stay for two extra days for observation after a surgery that usually doesn’t require hospitalization. The pricing of these services is not regulated, so they may be able to charge patients exorbitant prices. It is concerning that access to quality healthcare is at risk of becoming a privilege only available to the wealthy. This results in a fundamental mismatch between the business objectives and the goal of providing equitable healthcare for all.
The “Status quo”
Before World War II, healthcare in Canada was mostly delivered and funded privately. Saskatchewan introduced a province-wide universal hospital care plan in 1947, and other provinces followed suit shortly. Both British Columbia and Alberta launched similar plans by 1950. In 1966, the federal government of Canada passed the Medical Care Act to offer reimbursement or cost-share on provincial and territorial costs for medical services provided by doctors outside hospitals. All provinces and territories established universal physician services insurance plans within the following six years.
Since the inception of Canada’s healthcare system, it continues to be modified and reformed as population and circumstances change and the nature of healthcare itself evolves. However, basic values of fairness and equity with a demonstrated willingness to share resources and responsibility remain. The Canada Health Act is there “to protect, promote and restore the physical and mental well-being of residents of Canada”, and to facilitate universal coverage of medically necessary healthcare services for us based on our needs, not our ability to pay.
Those who support a more American-style approach argue that the U.S. system provides more choices, better services, and even higher efficiency. But a two-tier system doesn't automatically equate to more options or improved quality. According to a Commonwealth Fund study in 2021, the U.S. health system ranked last among 11 countries, which lags far behind a number of high-income countries like Norway, the Netherlands, and Australia, in terms of affordability, administrative efficiency, equity, and healthcare outcomes. The American-style system will lead to difficulty in accessing and affording needed healthcare for the majority as income inequality widens and inflation skyrockets. It is clear that the American approach is not a viable solution for Canada.
In Europe, we start to see the UK failing the privatization of their National Health Service (NHS) care accelerated a decade ago. A 2022 analysis by the University of Oxford shows that handing over healthcare services to profit-driven entities has corresponded with a continuous drop in quality and a significant rise in avoidable death. A meta-analysis by Brock University also shows that private for-profit ownership of hospitals results in a higher risk of death for patients when compared with those run on a not-for-profit basis.
Doug Ford compared Ontario’s healthcare system to North Korea by recounting how an unnamed hospital CEO allegedly confided to him that our single-tiered system is run in the same way as those in communist countries. Despite his rhetoric about the need for change, he pushes privatization without realizing it will result in thousands of preventable deaths.
A better system
Some critics in North America often describe the Canadian healthcare system as inefficient in terms of cost and delivery of care, and argue that a single-payer system is not necessary for universal healthcare. However, many of the countries with the highest-performing healthcare systems in the world have adopted a single-payer system and have a substantial role for the state in providing healthcare services.
Sweden, for instance, has a universal health system that is primarily funded through a combination of regional and municipal taxes, with grants from the central government. Their system covers inpatient, outpatient, mental health, and long-term care, as well as dental and prescription drugs – a level of comprehensive coverage not currently available in Canada.
Norway, a top-ranked country in terms of healthcare system performance in the 2021 Commonwealth Fund report, showcases the efficiency and quality of a publicly managed system. It has a universally accessible system funded primarily through a combination of general taxes and payroll contributions from employers and employees. With primary health care organized at the municipal level, and specialty care and hospital services managed by state-owned regional health authorities, it demonstrates that a single-payer system can effectively provide comprehensive and accessible health coverage, rather than privatization.
Despite some healthcare systems in countries like Australia coexisting with a fair portion of market coverage, the government is still playing a significant role in financing healthcare. Approximately, 50% of Australians possess private supplementary insurance to pay for private hospital care and additional services. Yet, the federal government pays a rebate toward this premium and imposes a tax penalty on higher-income households that don't opt for private insurance, with the aim of reducing their dependence on the public health system.
In line with the belief in universal healthcare, it's crucial to strive for a robust health system where individuals don't feel compelled to seek private coverage. The success of a universal healthcare system can be seen in countries like Sweden and Norway, where the percentage of the population with private insurance is as low as 10%, and the majority, including those with private insurance, are still receiving comprehensive coverage through the publicly funded system.
What we are currently facing in Ontario is more than just surgery backlogs. Amidst the healthcare staffing crisis, burnout of healthcare workers will only continue to rise. Doctors and nurses are working long hours with excessive administrative burdens in a high-stress environment while being underpaid. A survey by The Canadian Medical Association (CMA) found physician burnout nearly doubled during the pandemic. A similar survey done by the Registered Nurses Association of Ontario also found more than 75% of the interviewed nurses are burning out in 2021.
Instead of diverting resources to for-profit clinics, the government should prioritize funding for public healthcare and invest in enhancing working conditions for healthcare professionals. This is essential because a well-functioning healthcare system relies on a robust workforce. Where there is no one-size-fits-all solution for healthcare, or no single system that is perfect and ready for us to just “copy-and-paste”, there are better ways to effectively address these challenges than a policy that runs counter to Canada’s core values.
Epilogue
“To call a deer a horse” (指鹿為馬) is a Chinese idiom that originates from The Records of Grand Historians (Shiji 史記) in which an ambitious Qin politician deliberately misrepresented a deer as a horse in front of the emperor to test for dissent and silence opponents. The idiom is often used to describe those who distort reality through deceit. Similarly, the Doug Ford government has rebranded for-profit clinics as "community clinics" and referred to the practice of "upselling" as "patient options," showing their tendency to manipulate the truth for their own gain.
On February 2 (just a day before this article is published), Ontario’s Health Minister Sylvia Jones announced a new healthcare plan to “connect” us to the “most convenient” care we need. That also included $30 million to create up to 18 new interprofessional primary care teams comprised of nurses, doctors and social workers to help marginalized groups. By expanding existing family health organizations, and launching a practice-ready assessment program for internationally educated physicians to register for practice in the province quicker, we will see at least 50 new doctors working in Ontario by 2024.
What do you think about the plan? Will this help 1.8 million Ontarians without family doctors access the “right care in the right place”?
Reference
Alberga, H. & Arsenych, A. (2023, February 2). Ontario releases new health-care plan to make access 'faster' and 'easier'. CTV News. Retrieved from https://toronto.ctvnews.ca/ontario-releases-new-health-care-plan-to-make-access-faster-and-easier-1.6256809.
Allan, D. (2023, January 17). Four ways the Ford government is privatizing health care. Canadian Dimension. Retrieved from https://canadiandimension.com/articles/view/four-ways-the-ford-government-is-privatizing-health-care.
Angell M. Privatizing health care is not the answer: lessons from the United States. CMAJ. 2008 Oct 21;179(9):916-9. doi: 10.1503/cmaj.081177. Epub 2008 Oct 6. PMID: 18838441; PMCID: PMC2565716.
Bogdan , S. (2022, november 3). Ontario family details the frustrating struggle to find a family doctor. Global News. Retrieved from https://globalnews.ca/news/9247607/health-care-system-crisis-ontario-find-family-doctor/.
Callan, I., & D'Mello, C. (2023, January 9). Ford government documents admit low wages, Bill 124 worsening health staffing issues. Global News. Retrieved from https://globalnews.ca/news/9340310/health-care-ontario-bill-124-ford-government-documents/.
Campbell, K. (2022, June 24). How Much is a Family Doctor Salary in Canada?. Dr. Bill. Retrieved from https://www.dr-bill.ca/blog/wealth-finances/salary-for-family-doctor-canada#Ontario.
Canadian Medical Association. (2022, March 23). Physician burnout nearly doubles during pandemic. Canadian Medical Association Website. Retrieved from https://www.cma.ca/news-releases-and-statements/physician-burnout-nearly-doubles-during-pandemic.
Canadian Museum of History. (2010, April 21). The Medical Care Act, 1966. Canadian Museum of History. Retrieved from https://www.historymuseum.ca/cmc/exhibitions/hist/medicare/medic-5h23e.html.
CBC News. (2022, August 12). Ontario isn't ruling out privatization in health care. Here's what that could look like. CBC News. Retrieved from https://www.cbc.ca/news/canada/toronto/emergency-motion-ndp-health-1.6548142.
CBC News. (2023, January 16). Ontario expanding number and range of surgeries offered at for-profit clinics. CBC News. Retrieved from https://www.cbc.ca/news/canada/toronto/ford-jones-health-surgeries-private-clinics-1.6715117.
Chan, C. (2013, April 10). Chinese Idiom: Point to a Deer and Call it a Horse (指鹿為馬). The Epoch Times. Retrieved from https://www.theepochtimes.com/chinese-idiom-point-to-a-deer-and-call-it-a-horse_13483.html.
Chemweno, J. (2021, July 27). The U.S. Healthcare System is Broken: A National Perspective. Managed Healthcare Executive. Retrieved from https://www.managedhealthcareexecutive.com/view/the-u-s-healthcare-system-is-broken-a-national-perspective.
Collaco, C. (2019, April 3). How Ontario doctors can get paid more to see you less. CBC News. Retrieved from https://www.cbc.ca/news/canada/hamilton/doctor-bonuses-1.5082488.
Crawley, M. (2023, January 13). Doug Ford government will give for-profit clinics bigger role in surgeries. CBC News. Retrieved from https://www.cbc.ca/news/canada/toronto/ontario-doug-ford-private-clinics-health-care-1.6712444.
Crawley, M. (2023, January 17). If cutting surgical wait-lists is the only goal, Doug Ford's plan could work. CBC News. Retrieved from https://www.cbc.ca/news/canada/toronto/ontario-doug-ford-surgery-wait-times-private-sector-clinics-1.6715340.
DeClerq, K. (2023, January 16). Ontario releases 3-step plan to invest in private care to reduce surgical backlog. CTV News. Retrieved from https://toronto.ctvnews.ca/ontario-releases-3-step-plan-to-invest-in-private-care-to-reduce-surgical-backlog-1.6232067.
DiCiocco, G. (2023, January 26). We can’t trust Doug Ford and Sylvia Jones to fix health care. The Hamilton Spectator. Retrieved from https://www.thespec.com/opinion/contributors/2023/01/26/we-cant-trust-doug-ford-and-sylvia-jones-to-fix-health-care.html.
Djuric, M. (2023, January 30). Singh meeting with Trudeau about private health care ahead of PM's sit-down with premiers. The Canadian Press. Retrieved from https://nationalpost.com/news/politics/ndp-to-call-for-emergency-debate-in-house-of-commons-over-private-health-care.
D'Mello, C. (2023, January 19). Ford government to allow out-of-province nurses to start work immediately in Ontario. Global News. Retrieved from https://globalnews.ca/news/9421673/ontario-allows-out-of-province-nurses-to-work/.
Fish, J. (2023, January 23). Is Ontario’s public health care on a slippery slope. The Big Story. Retrieved from https://thebigstorypodcast.ca/2023/01/23/is-ontarios-public-health-care-on-a-slippery-slope/.
Goodair, B., & Reeves, A. (2022, July). Outsourcing health-care services to the private sector and treatable mortality rates in England, 2013–20: an observational study of NHS privatisation.VOLUME 7, ISSUE 7, E638-E646, JULY 2022. The University of Oxford. Lancet Public Health journal. Retrieved from https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(22)00133-5/fulltext
Government of Canada. (2020, February 24). Canada Health Act. Government of Canada. Retrieved from https://www.canada.ca/en/health-canada/services/health-care-system/canada-health-care-system-medicare/canada-health-act.html.
Gray, J., & Cook, D. (2022, September 23). Ontario posts $2.1-billion surplus with higher-than-expected revenue. The Globe and Mail. Retrieved from https://www.theglobeandmail.com/canada/article-ontario-fiscal-numbers-deficit-surplus/.
Gregory, A. (2022, June 29). NHS privatisation drive linked to rise in avoidable deaths, study suggests. The Guardian. Retrieved from https://www.theguardian.com/society/2022/jun/29/nhs-privatisation-drive-linked-to-rise-in-avoidable-deaths-study-suggests.
Health Canada. (2019, September 17). Canada's Health Care System. Government of Canada. Retrieved from https://www.canada.ca/en/health-canada/services/health-care-system/reports-publications/health-care-system/canada.html.
Hopper, T. (2022, January 25). Why five million Canadians have no hope of getting a family doctor. National Post. Retrieved from https://nationalpost.com/opinion/why-five-million-canadians-have-no-hope-of-getting-a-family-doctor.
Ip, Y. (2018). To Call a Horse a Deer. MIT Open Documentary Lab. Retrieved from https://docubase.mit.edu/project/to-call-a-horse-a-deer/.
ISPOR. (n.d.). US Healthcare System Overview-Backgound. ISPOR Website. Retrieved from https://www.ispor.org/heor-resources/more-heor-resources/us-healthcare-system-overview/us-healthcare-system-overview-background-page-1.
Lan, D. (2018, May 18). “Calling a Deer a Horse” 指鹿为马. Lao Wai Da Wei 老外大卫. Retrieved from https://laowai-dawei.com/calling-a-deer-a-horse-指鹿为马/.
Legislative Assembly of Ontario. (2019, November 7). Bill 124, Protecting a Sustainable Public Sector for Future Generations Act, 2019. Ontario.ca. Retrieved from https://www.ontario.ca/laws/statute/s19012.
LockTalk. (2021, October 19). LockTalk 2: Everything you wanted to know about Bill 124. Ontario Public Service Employees Union Website. Retrieved from https://opseu.org/news/locktalk-2-everything-you-wanted-to-know-about-bill-124/135295/.
Miller, A., & Benjamin, S. (2022, August 20). Would more privatization in Canadian health care solve the current crisis?. CBC News. Retrieved from https://www.cbc.ca/news/health/canada-healthcare-privatization-debate-second-opinion-1.6554073.
Ministry of Health. (2022, September 22). Apply for OHIP and get a health card. Ontario. Retrieved from https://www.ontario.ca/page/apply-ohip-and-get-health-card.
Ministry of Health. (2023, February 2). Your Health: A Plan for Connected and Convenient Care. Ontario. Retrieved from https://www.ontario.ca/page/your-health-plan-connected-and-convenient-care.
NAWAZ, H. (2023, January 23). Doug Ford privatizing surgery to the pragmatic right’s applause. The Brock Press. Retrieved from https://brockpress.com/2023/01/23/doug-ford-privatizing-surgery-to-the-pragmatic-rights-applause/.
Nickerson, C. (2023, January 19). Premier says new plan will speed up process for health-care workers moving to Ontario. CBC News. Retrieved from https://www.cbc.ca/news/canada/windsor/windsor-doug-ford-sylvia-jones-thursday-1.6718648.
Ontario Council of Agencies Serving Immigrants. (2022, April 20). What is the Ontario Health Insurance Plan (OHIP)?. Settlement.org. Retrieved from https://settlement.org/ontario/health/ohip-and-health-insurance/ontario-health-insurance-plan-ohip/what-is-the-ontario-health-insurance-plan-ohip/.
Pipes, S. (2023, January 30). Canadian Leaders Finally Waking Up To The Horrors Of Single-Payer Health Care. Forbes. Retrieved from https://www.forbes.com/sites/sallypipes/2023/01/30/canadian-leaders-finally-waking-up-to-the-horrors-of-single-payer-health-care/?sh=3d1644ca5d1a.
Poisson, J. (Host). (2022, August 23). Ontario mulls private solutions for public healt-care crisis. In Front Burner. CBC Radio. Retrieved from https://www.cbc.ca/radio/frontburner/ontario-mulls-private-solutions-for-public-health-care-crises-1.6559171.
Poisson, J. (Host). (2023, January 18). Ford pushes for-profit care amidst healthcare crisis. In Front Burner. CBC Radio. Retrieved from https://www.cbc.ca/radio/frontburner/ford-pushes-for-profit-care-amidst-healthcare-crisis-1.6712425.
PressProgress. (2021, February 25). Doug Ford’s Government Is Looking For Private ‘Corporations’ To Perform Eye Surgeries In Ontario. PressProgress. Retrieved from https://pressprogress.ca/doug-fords-government-is-looking-for-private-corporations-to-perform-eye-surgeries-in-ontario/.
Quora. (n.d.). Why is it so hard to find a family doctor in Ontario? Is there actually a shortage?. Quora. Retrieved from https://www.quora.com/Why-is-it-so-hard-to-find-a-family-doctor-in-Ontario-Is-there-actually-a-shortage.
Reddit. (2021, April 25). Why is it so hard to find a family doctor?. Reddit. Retrieved from https://www.reddit.com/r/ontario/comments/my1ad0/why_is_it_so_hard_to_find_a_family_doctor/.
Reddit. (2023, January 16). Did Doug Ford just compare our healthcare to Cuba and North Korea?. Reddit. Retrieved from https://www.reddit.com/r/ontario/comments/10dheqp/did_doug_ford_just_compare_our_healthcare_to_cuba/.
Registered Nurses Association of Ontario. (2022, May 12). Deep crisis in nursing demands urgent action by government, employers, educators and associations. Cision. Retrieved from https://www.newswire.ca/news-releases/deep-crisis-in-nursing-demands-urgent-action-by-government-employers-educators-and-associations-880589938.html.
Ross University School of Medicine. (2021, May 11). US vs. Canadian Healthcare: What is The Difference?. Ross University School of Medicine. Retrieved from https://medical.rossu.edu/about/blog/us-vs-canadian-healthcare.
Schneider, E.C., Shah, A., Doty, M. M., Tikkanen, R., Fields, K., & Williams II, R. D. (2021, August 4). Mirror, Mirror 2021: Reflecting Poorly. The Commonwealth Fund. Retrieved from https://www.commonwealthfund.org/publications/fund-reports/2021/aug/mirror-mirror-2021-reflecting-poorly.
Smith, A., & Goldsbie, J. (Hosts). (2023, January 18). “Leveraged” Health Care on Ontario’s Dime. (Episode 50). In Wag The Doug. Canadaland. Retrieved from https://www.canadaland.com/podcast/50-leveraged-health-care-on-ontarios-dime/.
Stone, L. & Cook, D. (2023, Feb 2). Ontario announces $30-million for new primary care teams, commits to share data with Ottawa as health deal looms. The Globe and Mail. Retrieved from https://www.theglobeandmail.com/canada/article-doug-ford-ontario-healthcare-plan/.
Talbot, M. (2023, January 19). Ontario cutting 'red tape' to lure healthcare workers to Ontario: Ford. City News. Retrieved from https://toronto.citynews.ca/2023/01/19/ontario-healthcare-workers-ontario-doug-ford/.
Taylor, C. (2022, June 22). Finding a family doctor in Ontario, hard and getting harder. City News. Retrieved from https://kitchener.citynews.ca/local-news/finding-a-family-doctor-in-ontario-hard-and-getting-harder-5507053.
The Canadian Press. (2023, February 2). Ontario in 'full support' of federal push to tie health-care funding to data. CBC Retrieved from https://www.cbc.ca/news/canada/toronto/ontario-health-care-1.6734734.
The Commonwealth Fund. (2021, August 4). NEW INTERNATIONAL STUDY: U.S. Health System Ranks Last Among 11 Countries; Many Americans Struggle to Afford Care as Income Inequality Widens. The Commonwealth Fund. Retrieved from https://www.commonwealthfund.org/press-release/2021/new-international-study-us-health-system-ranks-last-among-11-countries-many.
Thompson, M. (2023, January 16). Doug Ford Will Outsource ‘50%’ of Ontario Surgeries to Private, For-Profit Health Facilities. PressProgress. Retrieved from https://pressprogress.ca/doug-ford-will-outsource-50-of-ontario-surgeries-to-private-for-profit-health-facilities/.
Thompson, M. (2023, January 17). Ontario’s Health Minister: Surgeons Allowed to ‘Upsell’ Patients To Make More Money. PressProgress. Retrieved from https://pressprogress.ca/ontarios-health-minister-surgeons-allowed-to-upsell-patients-to-make-more-money/.
Tikkanen, R., Osborn, R., Mossialos, E., Djordjevic, A. & Wharton, G. A. (2020, June 5). International Health Care System Profiles: Australia. The Commonwealth Fund. Retrieved from https://www.commonwealthfund.org/international-health-policy-center/countries/australia.
Tikkanen, R., Osborn, R., Mossialos, E., Djordjevic, A. & Wharton, G. A. (2020, June 5). International Health Care System Profiles: Canada. The Commonwealth Fund. Retrieved from https://www.commonwealthfund.org/international-health-policy-center/countries/canada.
Tikkanen, R., Osborn, R., Mossialos, E., Djordjevic, A. & Wharton, G. A. (2020, June 5). International Health Care System Profiles: Norway. The Commonwealth Fund. Retrieved from https://www.commonwealthfund.org/international-health-policy-center/countries/norway.
Tikkanen, R., Osborn, R., Mossialos, E., Djordjevic, A. & Wharton, G. A. (2020, June 5). International Health Care System Profiles: Sweden. The Commonwealth Fund. Retrieved from https://www.commonwealthfund.org/international-health-policy-center/countries/sweden.
Wikipedia. (2023, January 6). Records of the Grand Historian. Wikipedia. Retrieved from https://en.wikipedia.org/wiki/Records_of_the_Grand_Historian#:~:text=Records%20of%20the%20Grand%20Historian%2C%20also%20known%20by%20its%20Chinese,of%20China's%2024%20dynastic%20histories.
Wright, T. (2023, January 17). Moving public health services to for-profit clinics raises ‘legitimate concerns’: Duclos. Global News. Retrieved from https://globalnews.ca/news/9416382/public-health-for-profit-clinics-legitimate-concerns-duclos/.
Zafar, A., & Birak, C. (2022, October 23). An idea to streamline the operating room got patients into surgery sooner. CBC News. Retrieved from https://www.cbc.ca/news/health/surgicentre-operating-room-1.6623980.
Ziafati, N. (2022, August 11). 5 things experts say could ease pressures on Ontario’s health care system. The Canadian Press. Retrieved from https://globalnews.ca/news/9052626/ontario-health-care-system-relief-suggestions-experts/.
Zimonjic, P. (2023, January 2). More money is a must, but health-care delivery also needs a major rethink, doctors say. CBC News. Retrieved from https://www.cbc.ca/news/politics/healthcare-crisis-doctors-hospitals-rethink-1.6695642.