A recent survey by Ipsos Reid, commissioned by the Canadian Medical Association, finds that more Canadians (53 per cent) are worried about health care than the economy (45 per cent), climate change (42 per cent), immigration (32 per cent) and education (23 per cent).

And there’s good reason for concern.

Canada has one of the most expensive universal health-care systems in the world. In 2016, on an age-adjusted basis, Canada ranked fourth highest for health-care expenditure as a percentage of GDP and 10th highest for health-care expenditure per capita. Further, health care is the single largest budget item in every province. Of course, high levels of spending are not necessarily a bad thing if they are accompanied by commensurate results. Unfortunately for Canadians, that simply isn’t true.

For example, in 2016 Canada had the second-lowest physician-to-population ratio (ranking 26th out of 28), fewer MRI and CT scanners than the average (rank 22 and 21 out of 27, respectively) and the second-lowest number of beds per thousand (ranking 25 out of 26).

Things look even worse when we examine wait times data. Of the 10 countries with available data, Canada ranked worst (10th out of 10) for the percentage of patients who reported waiting two months or more for a specialist appointment, and worst (10th out of 10) for the percentage of patients who reported waiting four months or more for elective surgery.

Finally, the majority of survey respondents reported worrying a lot about long wait times (62 per cent), the shortage of health professionals (60 per cent) and crowded hospitals (59 per cent).

Of course, it isn’t all doom and gloom. Canada had a mixed record on indicators measuring the number of medical services delivered, and quality (doing particularly well on cancer survival rates). However, data revealing our poor availability of key medical resources and long wait times underscore why respondents to the Ipsos Reid survey are so concerned about the future of our health-care system.

To be clear, Canada’s poor performance has nothing to do with its commitment to universal health care—it’s about the way we’ve chosen to structure our health-care system. Countries that routinely outperform Canada do universal health care differently.

Switzerland, which spends more, but also has significantly more physicians, nurses and beds per thousand people, requires residents to buy insurance from private providers in a regulated (but competitive) market (subsidizing those in financial need). It also requires patients to pay a deductible before insurance kicks in, and a 10 per cent co-pay up to an annual maximum.

Meanwhile in Germany, where no patient reported waiting longer than four months for elective surgery, individuals can opt out of the public plan and buy private insurance. And although 42 per cent of hospitals are for-profit institutions, 99 per cent of all beds are accessible to individuals with public insurance.

In fact, like Switzerland and Germany, most countries that outperform Canada (including Australia, the Netherlands and France), generally embrace the private sector as a partner, expect patients to share in the cost of treatment and fund hospitals based on activity.

By contrast, private insurance for medically necessary care is effectively prohibited in Canada, co-pays (even with exemptions for vulnerable groups) are considered anathema to the concept of universal care, and hospitals are funded using global budgets (which treat patients like a cost instead of incentivizing activity).

For the last two decades Canada’s health-care system has been characterized by unsustainable increases in health-care spending (again, the largest budget item in every province) coupled with policy inertia. Importantly, apart from small experiments with private activity in Saskatchewan and Quebec, provincial governments have turned a blind eye to what works elsewhere.

The result of this disastrous policy mix is a very expensive health-care system with significant challenges that remain unaddressed—long wait times, limited resources and no alternatives for patients within our borders.

The Ipsos Reid poll suggests Canadians are well aware of this dire situation and the bleak outlook for our health-care system. It’s time for policymakers and provincial leaders to consider reform based on international experience, before it’s too late.