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 an 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 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.