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Hunter Prize: A pan-Canadian digital highway: Using teleradiology to reduce wait times 

Commentary

The Hub’s first annual Hunter Prize for Public Policy, generously supported by the Hunter Family Foundation, focused on solving the problem of long wait times in Canada’s health-care system. A diverse group of ten finalists have been chosen from nearly 200 entries, with the finalists and winners chosen by an esteemed panel of judges, including Robert Asselin, Dr. Adam Kassam, Amanda Lang, Karen Restoule, and Trevor Tombe. The Hub is pleased to run essays from each finalist this week that lay out their plans to help solve this persistent policy problem. The winners of the first-ever Hunter Prize for Public Policy will be announced on Friday, September 29.

Canada’s health-care system, plagued by prolonged wait times, finds itself at an inflection point. Some of the many services that Canadians wait for are the results of various diagnostic imaging scans. Data points, such as a 5.4-week national average for CT scans and staggering 20-week waits for MRIs in jurisdictions like Nova Scotia, underscore a pressing need for policy intervention. 

The solution: establishing a pan-Canadian teleradiology network. This model promises interoperability—a key principle of the Canada Health Act—and responsiveness, optimizing expertise from radiologists across jurisdictions and reducing the waiting periods for essential diagnostics like CT scans, MRIs, and ultrasounds. Such a network will create an interconnected ecosystem that systematically shares medical imaging and expertise across the entire country. Think of it as a digital highway for radiology. 

Consider the following scenario: in New Brunswick, radiology resources face pressure from heightened demand, compounded by a limited pool of radiologists. As a result, median wait times in this province reach eight weeks for CT scan interpretations and 12 weeks for MRIs, primarily due to the scarcity of specialists available for timely image evaluations. In contrast, Ontario boasts a better radiology infrastructure with a larger pool of radiologists. However, due to the current fragmented system, Ontario’s wealth of expertise is not set up to address the shortfall in New Brunswick. 

The repercussions of these delays extend beyond the health sector. The Conference Board of Canada reports that in 2018, a 30-day delay in MRI and CT scan services resulted in an economic hit of $3.54 billion. Systemic inefficiencies prevented nearly 380,000 Canadians from their work, resulting in a tax revenue loss of $430 million. 

A pan-Canadian teleradiology network will ensure that medical images from one jurisdiction can be transmitted to another jurisdiction with available capacity. It is like having a library of radiologists at your disposal. If doctors in one jurisdiction are unavailable, the system quickly finds other qualified doctors to help, ensuring that patients receive prompt care regardless of their geographic location. This interoperability ensures that every Canadian, no matter where they reside, has timely access to top-tier diagnostic care. By connecting patients with available teleradiologists, the system can adapt to surges and declines in diagnostic demand, ensuring steady care delivery during periods of increased need while accommodating regional differences in demand. 

While the network’s potential remains largely untapped at the national level, isolated provincial and territorial networks show promise. A salient example is the collaboration between a hospital in Iqaluit, Nunavut, and radiologists at The Ottawa Hospital. Before Iqaluit’s 2010 CT scanner acquisition, patients traveled to Ottawa, incurring costs of up to $25,000 and two-week stays. By implementing teleradiology services, Iqaluit patients benefited from localized imaging complemented by expedited interpretations from Ottawa-based radiologists, leading to cost efficiencies, diminished wait periods, and a reduction in the emotional and logistical burdens of extended travel. 

Prince Edward Island’s pioneering use of teleradiology to reduce CT scan wait times, combined with Ontario’s Northern Telecommunications Health Network’s efforts to serve remote areas, are additional examples of policy-driven approaches in teleradiology delivery. The Canadian Drug and Health Technology Agency indicates that eight provinces and territories permit teleradiology within their borders. Of these, six accept services from outside their boundaries. Illustrating the strain on resources, two territories rely on a shared radiologist, while Quebec turns to international teleradiology providers. Given these patterns, the bottom line is clear: Canada requires a pan-Canadian policy framework to ensure teleradiology is accessible across the country. 

Canada’s move towards teleradiology is not simply about harnessing existing technological capabilities, as many hospitals, provinces, and territories are already primed for its adoption. This transition underscores a policy imperative, urging a shift in how radiology services are delivered and regulated. Central to this is the Picture Archiving and Communication System (PACS), integral for efficient medical image storage and transfer. A majority of Canada’s radiology facilities already have PACS capability. 

Drawing parallels, the Pan-Canadian Pharmaceutical Alliance, established in 2010, demonstrates the strength of coordinated healthcare initiatives. By navigating the complexities of provincial drug negotiations, and with assessments from established review bodies, the alliance showcases the tangible fiscal benefits of unified policy strategies and provincial/territorial collaboration—realizing savings of $3.41 billion on reduced drug prices annually. Such successes are a blueprint for designing a pan-Canadian teleradiology network that can accommodate the unique health-care challenges faced by each jurisdiction. 

For a truly interconnected teleradiology ecosystem, policy guidelines need to encourage inter-provincial PACS integration, drawing inspiration from successful models like the U.K.’s National Health Service and America’s Veterans Health Administration. The latter’s public-private partnership approach has witnessed a surge in operational efficiency by 44 percent, translating into tangible benefits: faster processing times, streamlined workflows, and a visible reduction in patient wait times. 

Realizing this vision is within reach with the right funding strategies. Beyond tapping into federal health agreements, avenues like the Canada Health Infoway Fund—a $50 million federal fund earmarked for provinces and territories to build pan-Canadian virtual care programs—and partnerships with the private sector should be pursued. These investments can produce strong returns on investment, reflecting the benefits teleradiology brings to the table: from economic gains to enhanced patient care and accessibility. 

A pan-Canadian teleradiology network aims to optimize radiology services across the country, ensuring timely and efficient diagnostics for all Canadians. Teleradiology infrastructure for a more robust cross-provincial and territorial network exists, and smaller-scale collaborations have proven successful. Ottawa’s ability to convene all jurisdictions can launch the creation of a truly pan-Canadian network that can meet the fluctuating demands of radiology services across the country. The federal government’s role in aligning expertise and resources will serve as a linchpin for reducing diagnostic wait times and transforming overburdened provincial and territorial health-care systems. 

Jon Hartley: Is the ‘New Ottawa Consensus’ killing our economy?

Commentary

With Parliament back in session, the recent wrapping up of Canada 2020’s 2023 Global Progress Action Summit in Montreal (which was attended by almost every progressive anglosphere and Nordic prime minister in recent times), and a looming Canadian federal election that looks like it will be centered on economics issues, it’s well worth taking a hard look at how economic policy has shifted in Canada over time, particularly as the U.S. examines the direction of its own economic policy.

At the same time, there is an intense debate currently ongoing in the U.S. about what the new consensus on economic policy is between the ascendant “New Right” and the socialist Left. White House National Security Advisor Jake Sullivan argued in an April speech that there is a “New Washington Consensus” on economic policy, speaking of some new ideas in vogue like industrial policy while castigating the free market policies of a generation ago as being out of fashion.

But what exactly was the “Washington Consensus” phrase that so many people use to describe the old free-market-oriented economic policy regime promoted across party lines by the Reagan, Bush 41, and Clinton presidencies and beyond? British economist John Williamson originally defined the Washington Consensus as a set of 10 principles to guide the Latin American response of the 1980s to the crises of the 1970s, something which also came to define the neoliberal economic policies promoted both domestically as well as internationally by policymakers in Washington D.C. 

This original Washington Consensus, promoted around the world in economic policymaking by several administrations through aid agencies like the IMF and World Bank, was a catalyst for economic mobility and lifting billions of people out of poverty. The period under which the Washington Consensus was dominant (dubbed “The Age of Milton Friedman” by Harvard economist Andrei Shleifer) coincided with rapid reductions in absolute poverty (the share of people in the world living under $1/day fell significantly), significant reductions in infant mortality together with increases in life expectancy, and educational attainment.

Graphic credit: Janice Nelson.

Williamson’s ten principles of the Washington Consensus were:

1. Fiscal policy discipline and avoiding of large fiscal deficits relative to GDP;

2. Redirect public spending away from subsidies toward broad-based provision of key pro-growth, pro-poor services like primary education, primary health care, and infrastructure investment;

3. Tax reform, namely broadening the tax base and adopting moderate marginal tax rates;

4. Market-determined interest rates that are positive in real terms;

5. Competitive exchange rates;

6. Trade liberalization;

7. Liberalization of inward foreign direct investment;

8. Privatization of state enterprises;

9. Deregulation;

10. Legal security for property rights.

Since then much has changed. Donald Trump was elected on an economic platform that rejected free trade in favour of retaliatory tariffs and quotas, many of which have continued throughout the Biden regime which has even enacted new tariffs on food-can metal from Canada, Germany, and China. A group of anti-free market proponents ranging from U.S. senators to powerful Washington think tanks, loosely defined as the “New Right,” has emerged as a very powerful new coalition in the GOP in the same way that the socialist Left has become ascendant in the Democratic Party. As a result, the Democratic Party has begun to rethink its stance on free trade. This was particularly evident when they forced 2016 Presidential candidate Hillary Clinton to revoke her support for the Trans-Pacific Partnership, the same trade deal she negotiated and termed the “gold standard.”

Indeed, it seems as if these two groups are attempting to form a “New Washington Consensus.” From my perspective, the New Washington Consensus is concretely defined by ten new principles: 

1. Lack of fiscal policy discipline on debt and large fiscal deficits; 

2. More progressive taxation; 

3. Central bank-determined interest rates with inflation targets and quantitative easing; 

4. Flexible market-determined exchange rates with limited interventions; 

5. Trade barriers, quotas, and tariffs; 

6. Capital controls against hot capital inflows; 

7. Lender of last resort bailouts for too-big-to-fail Institutions; 

8. Industrial policy to meet economic objectives;

9. Aggressive antitrust enforcement; 

10. Growth of regulation through the administrative state.

Canada was a major exponent of the old Washington Consensus, which crystallized in the late 1980s, as evidenced by the Macdonald Commission and the Mulroney government supporting the North American Free Trade Agreement (NAFTA), the Chretien-Martin fiscal reform in the 1990s and fiscal surpluses in the Harper years, along with more free trade deals along the way. But now, Canada is very much shifting toward a new consensus as well. Perhaps a “New Ottawa Consensus”? 

There has been a consequential lack of fiscal discipline since the Liberals took power in Canada in 2015. The famous Trudeau notion that “budgets balance themselves” never came to pass. Canada’s deficits have increasingly been out of control through the COVID-19 pandemic (not unlike many countries around the world which similarly lack fiscal discipline).

The growth in regulations has ground the Canadian energy industry to a halt, preventing any hope for further pipelines both within Canada and across the U.S. border, along with any hope of developing the capability of exporting natural gas through the building of a liquified natural gas terminal.

Arguably Canada is further along than the U.S. in terms of entering a new economic consensus. Trade deals have taken a back seat to retail politics under Trudeau. Canada is now open to criticizing its most important ally to the south, including issuing political travel advisories and reigniting tensions in the softwood lumber dispute and other subsidies. Trade negotiations with India have also been completely derailed.

Addressing the recent run-up in housing costs has been the central economic issue of our time in Canada. Provincial foreign buyer taxes and, now, an outright national ban on foreign buyers is a total affront to the old Washington Consensus IMF doctrine of free capital flows. 

How has this New Ottawa Consensus been working for Canada? GDP per capita has been flat for much of the past decade, which is one indication that it has not been going particularly well. 

Pierre Poilievre’s approach opens a new front that if anything is more friendly to the old consensus of free markets. Poilievre has correctly identified that the chief problem with the cost of housing is excessive land use regulation, which can be best solved by creating incentives that loosen land use regulations.

The Canadian Conservatives could very well come to power in the coming years and help revert policy back to the old consensus of more market-oriented policies. 

That being said, such a task would be no easy undertaking. The expansion of the welfare state has been massive under Trudeau. In a world with defined benefits and diffuse costs, it is incredibly difficult to undo or reform new government programs whether it be universal dental care or child care that have been passed under the Trudeau government. 

An estimated 11,000 Ontarians have died while waiting for surgeries, MRIs, and CT scans in the past year. Meanwhile, any discussion of health-care reform or moving to a two-tiered public-private health system is immediately dead on arrival.

Maybe the New Ottawa Consensus is here to stay.