In the midst of the ongoing problems with Canadian health care, one possible solution often discussed is to scale back on medical administrators and use the financial resources thus made available to hire more frontline medical professionals.
In other words, hire more doctors and nurses and fewer paper pushers.
Proponents of this idea often compare the Canadian health care system to Germany’s.
To normalize for different populations, as Germany has 83.2 million people, over twice Canada’s population, Canada has approximately one health care administrator for every 1,415 people, Germany approximately one for every 15,535.
This means that per-population, Canada has 11 times more health care administrators than Germany.
Now, it is possible that this difference is required, as different health care systems may have different needs.
To compare, the German system is multi-payer.
While just over 75% is publicly funded, almost 25% is covered by private health insurance.
Canada’s is a single-payer system for all medically necessary services. For other medical services, private health insurance is available.
Estimates put Canada’s health care expenditure at approximately 12.2% of Gross Domestic Product, Germany approximately 12.8%, so the countries are close on that metric.
But all of this may be irrelevant depending on what the classification of hospital administrator means and on what they actually do.
There are no international standards for hospital accounting and even the definition of “hospital” varies internationally.
One country’s hospital administrator may include hospital executives, another’s may not. The waters get muddy.
Some international definitions of “hospital administrator” include virtually every role that is not working with a patient, lab analysis, or doing frontline facilities management, such as cleaning.
The other issue is that we are not really looking at hospital administrators but health care administrators.
Perhaps data only looking at senior health care government bureaucrats and senior hospital executives in major urban centres paid hundreds of thousands of dollars annually would be different, but the conversation about doctors and nurses versus paper pushers is focused on what are described as health care administrators.
The issue is also complicated by the role of public health care workers, whose job is to prevent people from needing to go to hospital, by keeping then healthy.
If the debate is about funding frontline medical care versus funding public health initiatives, the math becomes exceptionally complicated.
It is clear though, regardless of definitions, administrators in hospitals are not providing frontline care to patients, so what about comparing the number of doctors and nurses?
In 2020, Canada had approximately 2.77 doctors per 1,000 population, and 10.06 nurses per 1,000.
Germany had approximately 4.53 doctors per 1000, and 12.06 nurses per 1,000.
That translates to Germany having 1.635 times more doctors and 1.199 times more nurses per 1,000 population.
Regardless of how health care administrators are defined, over 60% more doctors and almost 20% more nurses are a lot of health care professionals.
Now consider the availability of family doctors in Canada relative to population.
In Ontario, 2.2 million people out of a population of 14.57 million do not have a family doctor — 15%.
In B.C., just under one million people out of a population of 5.07 million do not have a family doctor, slightly under 20%.
Alberta reports one-in-five people do not have a family doctor, also 20%.
In the Yukon, about 5,000 people out of 44,238, or 11.3%
If Canada had a proportionate number of doctors to Germany distributed amongst all types of doctors, we would have over three times the number of additional family doctors needed to address the relative scarcity of doctors.
In 2021, there were 47,337 family doctors in Canada who made an average of $230,000 a year. Increasing that by 60% would be 28,402 more doctors with a corresponding increased cost of $6.53 billion.
While the average medical administrator’s salary is $39,315, it can go up to $79,615 for a hospital administrator.
Even using the higher number, finding $6.53 billion to hire 28,402 more doctors would mean firing 82,050 medical administrators.
But there are only about 27,000 medical administrators in Canada.
That would mean we would need to fire every medical administrator in the country to make up for just a part of the increased cost of addressing just one issue in Canadian health care — the shortage of family doctors.
— Vezina is the CEO of Prepared Canada Corp. and teaches Disaster and Emergency Management at York University. He can be reached at info@prepared.ca
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