Saskatchewan's recently announced Patients First Health Care Plan arrives 17 years after the Patient First Review Commissioner's 2009 report, prompting some to wonder if this time the government truly means it. The plan emphasizes expansion across multiple fronts, but critics argue it misses a crucial opportunity to address systemic waste.
The Addition-Only Approach
The new Saskatchewan health strategy doubles down on more services across the board. It calls for increased surgical capacity, expanded medical imaging availability, enhanced training programs, and aggressive recruitment efforts. This expansion comes with significant financial implications, with projected health care spending reaching $6,700 per person in 2026-27, totaling an impressive $8.47 billion for the province.
Public opinion appears to support such investments. A 2025 Ipsos poll revealed that 80 percent of Canadians would endorse additional government spending specifically targeted to health care, even amid global economic turbulence and rising deficits. Governments continue to oblige this preference, while citizens who scrutinize other areas of public spending often give health care expenditures a pass.
The Missing Subtraction Component
While Saskatchewan's proposed additions to the health spending menu represent standard fare, the plan conspicuously lacks any strategy for reducing low-value care. This omission mirrors approaches across Canada, where health systems excel at addition but struggle with subtraction.
A substantial body of physician-led research has identified dozens of low-value tests, procedures, and medications that provide minimal benefit to patients. These include routine head CT scans in many circumstances, knee arthroscopy for adults over 60, removal of asymptomatic gall bladders, breast removal for early-stage cancer in certain cases, and imaging for uncomplicated lower back pain.
The Cost of Excess
The financial impact of unnecessary medical interventions can be staggering. A recent Alberta study examining just one specialty revealed that excess cardiology testing in for-profit private clinics cost the province approximately $700 million over 25 years. This represents merely one battery of tests within a single medical specialty, suggesting the total system-wide waste could be substantially higher.
Experts estimate that as much as 30 percent of health care spending may constitute overuse and waste. While some people struggle to access necessary care, the parallel reality within massive health systems involves significant resources devoted to interventions of questionable value.
Pruning as a Core System Duty
Health care fundamentally aims to improve health outcomes beyond what would occur without intervention. Pruning low-value care should therefore represent a core system responsibility, with success beginning with simple acknowledgment that such waste exists.
International comparisons highlight alternative approaches. Costa Rica, with a GDP per capita approximately one-third of Canada's and health system costs about one-quarter of ours, achieves health outcomes comparable to OECD averages. The bedrock of Costa Rica's system is primary care, where a team of four professionals—a doctor, nurse assistant, technical assistant, and medical clerk—serves approximately 5,000 people.
Compared to Canadian standards, this staffing ratio appears threadbare, yet Costa Rica demonstrates that focusing resources on effective interventions rather than expanding across all possible services can yield impressive population health results.
The Path Forward
The challenge for Saskatchewan and other Canadian jurisdictions involves shifting from an addition-only mentality to embracing strategic subtraction. This requires:
- Acknowledging the substantial evidence identifying low-value care
- Developing systematic approaches to reduce unnecessary interventions
- Reallocating saved resources to areas of genuine need
- Building public understanding that more health care isn't always better health care
As health systems face growing financial pressures and increasing demand, mastering the art of subtraction may prove as important as expanding services. The true test of the Patients First Health Care Plan may ultimately be whether it can address what to stop doing, not just what to start doing.
