Comparing Canada’s health-care system with other countries, Part 3: Access to Resources

The first two blogs of this series documented Canada’s relative scarcity of key medical resources and mixed performance on the volume of care and surgical services compared to other countries with universal health-care systems. In part three of this series, we compare differing levels of access to these resources.

While it’s important to examine the availability and utilization of medical resources, it’s also beneficial to measure access more directly. To do so, the Fraser Institute’s annual comparison of health-care system performance examines five indicators of timely access and one indicator of cost-related barriers to care. Unfortunately, the data suggest Canada performs poorly on all measures except one (where it’s on par with the average).

When examining the ability of patients to make same-day appointments when sick and their ability to find care after hours, Canada ranked 9th (at 41 per cent of patients answering in the affirmative) and 8th (at 39 per cent) out of 10 countries for which data were available in 2020.

These low rates are particularly shocking when you examine the rates of other high-performing countries. For example, Germany (ranked 1st) and the Netherlands (ranked 2nd) reported that 76 per cent and 71 per cent of patients were able to make same-day appointments, respectively. For accessing after-hours care, Australia (ranked 3rd at 56 per cent), the Netherlands (ranked 1st at 72 per cent) and Norway (ranked 2nd at 65 per cent) were the top performers in our 10-country cohort.

Countries were also surveyed on timely access to specialty and surgical care. When adults were asked if they had waited four weeks or less for an appointment with a specialist, only 38 per cent of Canadians answered in the affirmative ranking last—10th out of 10—in stark contrast to other high-performing countries such as the Netherlands (ranked 1st at 69 per cent), Switzerland (2nd at 68 per cent) and Germany (3rd at 67 per cent).

Country	Able to get same day appointment when sick	Rank	Very/somewhat easy getting care after hours	Rank	Waited less than 4 weeks for a specialist appointment	Rank	Waited less than 4 months for elective surgery	Rank	Experienced access barrier because of cost in past year	Rank
Australia	66%	3	56%	3	54%	5	72%	6	21%	9
Canada	41%	9	39%	8	38%	10	62%	10	14%	7
France	55%	5	43%	6	45%	6	90%	3	11%	4
Germany	76%	1	47%	5	67%	3	99%	1	11%	4
Netherlands	71%	2	72%	1	69%	1	87%	4	9%	2
New Zealand	63%	4	56%	3	58%	4	76%	5	18%	8
Norway	52%	8	65%	2	42%	8	71%	8	8%	1
Sweden	38%	10	24%	10	42%	8	71%	8	11%	4
Switzerland	54%	7	40%	7	68%	2	94%	2	23%	10
United Kingdom	55%	5	37%	9	45%	6	72%	6	10%	3
Average	57%		48%		53%		79%		14%

Source: OECD, 2021; Commonwealth Fund, 2021; calculations by authors

Even more worrisome, when asked if they had waited four months or less for elective surgery only 62 per cent of Canadians answered in the affirmative—again, ranking last (10th). In Germany (1st out of 10), 99 per cent of respondents were able to access elective surgical services within a four-month period. More than 90 per cent also received treatment within that time period in Switzerland (2nd at 94 per cent) and France (3rd at 90 per cent) with the Netherlands only slightly behind (4th at 87 per cent).

Although the pandemic may have influenced these numbers in 2020, Canada also lagged behind other universal systems on measures of timely access to specialist care and elective surgery pre-COVID, placing last (10th) on access to specialists and surgical care when compared with these same 10 universal systems in 2016.

Of course, in Canada there’s a frequently employed argument that the rationing of care remains an unfortunate yet unavoidable tradeoff for universal access with no financial barriers. However, even on indicators measuring cost barriers to access, Canada only performs on par with the OECD average with 14 per cent of patient responding in the affirmative (ranking 7th out of 10).

As we noted in previous blogs in this series, Canada has a relative scarcity of key medical resources and mixed record on utilization, despite ranking among the top spenders worldwide. Unfortunately, the data examined here reveal how Canada also underperforms on access to care—particularly timeliness measured by indicators of wait times for specialists and elective treatment. In the next part of this series, we’ll compare how Canada ranks on the quality health care alongside indicators that measure its clinical performance.