OP-ED: Canada remains poor performer among countries with universal health care

The Trudeau government announced earlier this year it will increase health-care spending to provinces and territories by $196.1 billion over the next decade. But patients hoping for improved access will likely be disappointed.

In reality, Canada’s health-care system already ranks as one of the most expensive systems in the world but only has mediocre results to show for it. In other words, the problem isn’t the amount of money we spend – it’s the poor value we get for our health-care dollars.

A new study compared the spending and performance of Canada’s system with 29 other universal health-care systems worldwide. According to the study (after adjusting for population age in each country), Canada was the highest spender on health care as a share of the economy (at 12.6 per cent) and ninth-highest on a per person basis in 2021, the latest year of available data.

And yet, compared to other universal countries, Canada reported far fewer physicians (ranking 28th of 30) and hospital beds (23rd of 29) per 1,000 people in 2021. And ranked low for the availability of MRI machines (25th of 29) and CT scanners (26thof 30) per million people in 2019 (the latest year of available data).

Unsurprisingly, scarce health-care resources are accompanied by long wait times. Using data collected in 2020 by the Commonwealth Fund, the study found that only 38 per cent of Canadians reported waiting less than four weeks for a specialist appointment –a much smaller percentage than countries such as Switzerland (68 per cent) and Germany (67 per cent).

On this indicator, Canada ranked 10th out of 10 countries. Canada also ranked dead last (10th) on timely access to elective surgery – with 62 per cent of Canadians reporting waiting less than four months – compared to 99 per cent of Germans and 94 per cent of Swiss. 

While these results were disappointing, Canada reported mixed results in other areas of performance. For example, although Canada performed poorly on safety indicators such as obstetric trauma during birth (23rd of 23 countries), it performed above the OECD average on other indicators including heart attack survival rates (9th of 25 countries). But while the Canadian system has in some areas performed in line with its high spending levels, overall it’s struggled to meet many of its basic obligations – especially timely access to care.

With its latest increase in health-care spending, the Trudeau government again ignores the fact that Canada already has one of the most expensive universal health-care systems in the world.

And although some of this new spending is predicated on provinces tracking progress and demonstrating improvement on certain indicators, international data reveal a simple truth – Canadians do not receive commensurate value for their health-care dollars. Without fundamental reform, it’s unlikely the new spending promised by the Trudeau government will produce improved performance for Canadian patients and their families.

GUEST OP-ED: Canada’s health-care wait times hit record high of 27.4 weeks

Mackenzie Moir and Bacchus Barua are analysts at the Fraser Institute.

Although the worst of the pandemic is now in the rearview mirror, Canada’s health-care system continues to struggle with poor resource and staff availability, health-care worker burnout, and chronic hospital overcapacity. And Canadians now also face the longest wait times for elective surgery on record.

According to the Fraser Institute’s latest annual survey of physicians, patients could expect a median wait of 27.4 weeks between referral to a specialist by a general practitioner and receipt of treatment in 2022, the fourth consecutive year wait times have increased. This year’s median wait is almost three times longer than the 9.3-week wait recorded in the first national survey in 1993, and 6.7 weeks longer than deemed “reasonable” by physicians.

The survey covers all 10 provinces across 12 core medical specialties and measures waits for “elective” surgeries, which are scheduled (in contrast to emergency surgeries) but are still medically necessary. If patients wait too long for some elective procedures, they may experience deteriorating health, permanent disability and sometimes death.

Of course, wait times vary considerably depending on the province and specialty. Prince Edward Island reported the longest wait time this year (64.7 weeks) while Ontario reported the shortest (20.3 weeks). We also see significant variation between specialties. For example, patients across the country face the longest waits for neurosurgery (58.9 weeks) and plastic surgery (58.1 weeks) while wait times for radiation (3.9 weeks) and medical oncology (4.4 weeks) were the shortest. 

To be clear, this isn’t a COVID problem. While the pandemic and associated surgical postponements may help partially explain why wait times have increased over the past three years, waits for elective surgeries were remarkably long before the first recorded case of COVID-19 in Canada—in 2019, Canadians faced a median wait of 20.9 weeks for elective care. 

The pandemic has also affected the research environment, with the national survey response rate this year coming in at 7.1 per cent. Although 850 specialists still responded to the survey, this year’s response rate is lower than in years preceding the pandemic. 

That said, these findings align with data from decades of domestic research and international surveys that reveal Canada’s poor access to timely care. For example, in 2020 the Commonwealth Fund (CWF) found that Canada ranked at the bottom (11th of 11) for both timely specialist appointments (under four weeks) and elective surgeries (within four months). A similar study from the CWF found similar results in 2016, long before the pandemic. 

Given these lackluster results and Canada’s continued and outsized reliance on the performance and generosity of our health-care workers, policy solutions are long overdue. 

For years, the research has revealed familiar findings. Other countries with similar or lower spending on health care (as a share of their economies), which outperform Canada, employ markedly different approaches to universal health care. Australia, Germany, the Netherlands, and Switzerland all either partner with the private sector for the financing and delivery of universal care, or rely on the private sector as a pressure valve when the public system is overburdened. They tend to also incentivize the responsible use of resources by expecting patients to share the cost of treatment (with exemptions for vulnerable populations), and fund hospitals based on activity (instead of Canada’s “global budgets”).

Of course, these countries also faced their own challenges during COVID. But the difference is they entered the pandemic with more resources and shorter wait times and will, therefore, likely emerge in a better position, too. 

If Canadians want to see their health-care system improve and wait times reduced, the provinces must consider bold reforms. It’s hard to imagine a more pressing policy issue in Canada today. 

Mackenzie Moir and Bacchus Barua are analysts at the Fraser Institute.


Related stories