COVID exacerbates—not creates—Canada’s long health-care wait times

As we approach the two-year mark of the onset of COVID-19 in Canada, a parallel health-care crisis has ensued—unacceptably long wait times. In 2021, Canadians could expect to wait an estimated 25.6 weeks (on average) between referral from a family physician and medically necessary treatment. While undoubtedly impacted by COVID, these waits have far more to do with longstanding failures of domestic policy than with the global pandemic.

This year marks the 30th iteration of the Fraser Institute’s annual survey of physicians. First designed and conducted in British Columbia with assistance from the province’s medical association, the survey expanded to cover all 10 provinces across 12 core medical specialties by 1993. Unfortunately, data collected over the last three decades reveal a steady deterioration in timely access to care. In fact, this year’s total wait (again, 25.6 weeks) marks the longest in the survey’s history and more than 2.5 time longer that the 9.3 weeks identified in the first national survey in 1993.

Among provinces this year, physicians in Nova Scotia (53.2 weeks) reported the longest total wait while those in Ontario (18.5 weeks) reported the shortest. Across Canada, patients waited longest between referral and treatment for neurosurgery (49.2 weeks) and orthopedic surgery (46.1 weeks) while shorter waits were reported for cancer care radiation (3.7 weeks) and medical oncology (4.4 weeks). Importantly, when taking all 12 specialities into account, physicians report that patients waited six weeks longer than what they consider clinically reasonable for treatment after consultation with a specialist.

It’s important to note that while these wait lists are largely for procedures technically considered “elective” (i.e. scheduled or planned treatment, in contrast to emergencies), they are all “medically necessary” and include treatments ranging from scheduled cataract removals to life-saving cardiac care. Excessive wait times can increase the stress and strain on patients and loved ones, lead to poorer health outcomes for patients, and in the worst cases, death.

Again, the pandemic has contributed to the long wait times over the last two years but it doesn’t account for almost three decades of documented wait-time increases. In fact, Canadians were already waiting 20.9 weeks (on average) for care in 2019, a year before the pandemic. COVID also created a more challenging research environment, which resulted in a 9 per cent national response rate from physicians for our wait-times survey, lower than in previous years. However, this response rate remains in line with other population-based surveys such as the Canadian Medical Association’s Physican Workforce Survey with its response rate of 12.8 per cent in 2019 pre-pandemic. It would be a mistake to ignore the experiences of the 1,178 physicians who responded to the Fraser Institute’s survey this year.

It’s also worth noting that other organizations reported similar findings. In 2020, the Commonwealth Fund ranked Canada at the bottom of 11 international health-care systems for speedy specialist appointments (under four weeks) and elective surgeries (under four months). It found similar results back in 2016, long before the pandemic.

So where do we go from here?

Of course, we must remain focused on combatting COVID and supporting our amazing health-care workers who’ve led us through this storm. However, we should also learn from other universal health-care countries around the world who don’t subject patients to the long wait times Canadians regularly experience.

Countries such as Germany, Switzerland and the Netherlands all approach universal health care in ways that differ from Canada. These countries form functional partnerships with their private sectors to provide timely high-quality care, incentivize responsible use of health-care resources through the use of cost-sharing (with protections for vulnerable populations) and fund their hospitals based on activity to better expedite surgical care. While they face similar challenges due to the pandemic, unlike Canada, these countries—and every other high-income universal health-care system—will likely return to a much better “normal” once the pandemic has passed.

If Canadians hope to experience wait times more comparable to other universal health-care countries, policymakers must substantially reform Canada’s health-care system so health-care professionals can provide treatment in a much more timely manner.