As the pandemic continues, the COVID—and non-COVID—health implications are becoming clearer in British Columbia. The Horgan government estimates it will take up to two years to complete the 30,000 cancelled “non-urgent” surgeries and address the additional 24,000 patients waiting for surgery referrals. Thankfully, the B.C. government’s response plan includes private clinics, but broader health-care reform is needed.

First, it’s important to clarify that most “non-urgent” surgeries (often called elective procedures) are not optional. Rather, they are medically necessary treatments scheduled or planned in advance including hip and knee surgeries, and cardiac bypass and stent procedures. In B.C., these cancellations have already had fatal consequences. According to the B.C. government, the backlog is “more significant than anything we have ever faced.” While likely true, B.C.’s health-care system faced major challenges before COVID-19.

For example, prior to the outbreak, British Columbians waited 12.7 weeks (on average) in 2019 to see a specialist after a referral from a GP—and then an additional 11.3 weeks to receive treatment after consultation with a specialist (for a total of 24 weeks). In 2019, these delays left 166,195 patients in the province waiting to receive treatment after seeing a specialist.

The knee-jerk response from governments across the country, including in B.C., is often to spend more money on health care. Given the rapid deterioration in government finances, this isn’t realistic. B.C.’s budget deficit is projected to reach $8.8 billion this year. Debt is also rising sharply. Simply put, most provinces, including B.C., are struggling with deficits and mounting debt. And federal finances are in worse shape than most provinces. The Parliamentary Budget Officer recently estimated that Ottawa’s deficit would eclipse $252 billion this year. This is the highest level on record and doesn’t include billions in additional spending announced over the last few weeks.

But even if governments could afford to spend more on health care, it’s unclear that increased spending would improve the system. Even in the pre-COVID world, there was mounting evidence that Canada spends more on its universal health-care system compared to other universal countries, while performing poorly in key areas. For example, despite being one of the highest-spending universal countries in the OECD (as a percentage of the economy), in 2017 Canada ranked low on number of doctors (2.8 per 1,000, ranking 26th of 28), acute care beds (2.0 per 1,000, ranking 26th of 27), MRIs (10.4 per million, ranking 21st of 26) and CT scanners (15.9 per million, ranking 21st of 27), on an age-adjusted basis.

In contrast, countries such as Australia are also struggling to clear their own elective surgery backlog, but have more doctors (4.0 per 1,000, ranking 6th of 28), MRIs (15.4 per million, ranking 11th of 26), and CT scanners (69.9 per million, ranking 2nd of 27) after adjusting for age. And fewer Australians (8 per cent) were waiting four months or longer for elective surgery than Canadians (18 per cent) in 2016, the latest year of comparable data.

So why the disparity between countries?

Simply put, other universal health-care systems embrace, to varying degrees, the private sector. Australia, for example, uses parallel private health care to augment its public system, allowing physicians to practise in both the public and private sectors, and contracts out the delivery of services to private hospitals. In Canada, we limit or effectively prohibit private-sector involvement in a significant portion of health care.

As noted, however, B.C.’s COVID backlog response will include limited partnership with private clinics. This type of initiative is not without precedent in Canada. In 2010, the aptly-named Saskatchewan Surgical Initiative used private clinics to provide publicly-funded surgeries and helped Saskatchewan lower its wait times from Canada’s longest (28.8 weeks in 2008) to the shortest by 2015 (13.6 weeks). It’s also worthwhile noting that private clinics in Saskatchewan provided services at a lower cost per procedure compared to public hospitals.

The impact of COVID-19 on the provincial health-care system underscores the need for greater flexibility to increase treatment options for patients within a universal framework. Simply throwing more money at the system is not a viable solution.