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Uzelman: Canadian health care performance well below other countries

A column by Bruce Uzelman

Health-care systems in B.C. and across Canada have faltered.

Canada’s performance, relative to other countries, has been and remains weak.

According to a recent report from the Fraser Institute (FI), Canada spends more on health care as a percentage of GDP than any other developed country with a universal health-care system.

Despite this, Canada’s health care performance is “modest to poor.”

The FI suggests Canada adopt practices from other countries that provide better results.

These include expanding private sector involvement in the delivery of universal health care, tying funding to treatments provided to patients, and requiring patients with the means to share the cost of treatment.

However, provinces have adopted few significant health-care reforms.

Political orthodoxy in Canada dictates that public institutions must provide universal health care, and inspires the Canada Health Act.

Fear of challenging the orthodoxy and being accused of “Americanizing the system,” and the rigidity of the CHA, have kept the system much the same it has always been.

Lack of reform, evidently, has created a shortage of health-care resources.

“Data suggests that Canada has substantially fewer human and capital medical resources than many peer jurisdictions that spend comparable amounts of money on health care,” noted Mackenzie Moir and Bachus Barua, the authors of the FI report, “Comparing Performance of Universal Health Care Countries, 2023.”

The report examines 40 health-care indicators across four categories. Moir and Barua draw attention to five key metrics.

Canada, of the 30 countries studied, scores among the lowest (from 23rd to 28th) for availability of doctors, care beds, MRI units and CT scanners. And Canada scores 30th of 30 countries for surgical wait times. (It is at or near the bottom on all four wait time indicators.)

Canada has fallen behind across other metrics as well, including a number of quality of care indicators.

A related FI report shows Canada’s wait times from GP to specialist to treatment tripled from 9.3 weeks in 1993 to 27.7 weeks in 2023. B.C. wait times increased from 10.4 to 27.7 weeks over the same period.

It is no surprise, then, that only 28 per cent of Canadians currently think their provincial health-care system is good, while 35 per cent think it is fair and 37 per cent poor, according to a new Leger poll.

Forty per cent of B.C. residents rated the system as good; 40 per cent of Canadians believe the system will stay the same over the next two years; 36 per cent believe it will get worse; and a meager 17 per cent think it will get better.

But there is at least one province that reduced surgical wait times dramatically with innovative and substantial reforms, at least for a time.

In 2010, the Saskatchewan government introduced the Saskatchewan Surgical Initiative (SSI). The SSI reforms included: a revamped scheduling service for specialists, training of additional operating room nurses, and the addition of private sector providers in the two largest cities.

All of these actions contributed to an expanded diagnostic and surgical capacity.

The SSI transformed wait times of 26.5 weeks to 14.2 weeks over four years, and the private clinics reduced the costs of the procedures by 20 per cent.

The SSI ended in 2014. Unfortunately, wait times again began to increase significantly, returning to 26 weeks by 2019.

Janice MacKinnon, a former NDP finance minister of Saskatchewan, wrote a report on SSI in 2016. MacKinnon concluded the SSI successfully reduced wait times and the suffering related to them, as intended.

However, she wrote, SSI addressed the symptoms of the problem, long wait times, not the problem itself, how Medicare is funded and structured.

MacKinnon also detailed the growth of public awareness of health-care wait times in the 1990s in Saskatchewan.

The FI began to provide yearly reports on wait times in 1993. That empowered residents with information and emboldened them to speak up, as wait times spiked.

This forced the government to act, ineffectively at first. Then in 2007, the new Saskatchewan Party government established an enquiry, which urged government action and from which the SSI emerged.

In the last decade, wait times perhaps have been increasingly tolerated across the country, and government reforms in most provinces have been tentative and ineffective.

If residents do not demand their provincial governments abandon orthodox health-care practices, the provinces will apparently continue to offer the same pseudo-solutions.

And if citizens and provincial governments do not demand that the federal government reform the inflexible, ideological provisions of the Canada Health Act, the Trudeau government, too, will surely continue to support those provisions.

Meaningful change will be impossible.

In other developed countries with more successful universal health-care systems, the private sector has integral roles in the system, unlike in Canada. These roles vary from country to country, but are always present.

The time for real change is now.


Bruce W. Uzelman, based in Kelowna, holds interests in economics and political science.

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