Canada can learn lessons from Europe to fix our broken health-care system

Canada’s health-care system is collapsing—and more money isn’t going to fix it. Long before the pandemic, patients endured some of the longest wait times for medically necessary care in the developed world. At the same time Canadians footed one of the largest bills for a universal health-care system. And things have only gotten worse.

Data collected over the past 30 years reveals a steady deterioration in access, with the median wait from referral to treatment increasing 124 per cent from 9.3 weeks in 1993 to 20.9 weeks in 2019, before the pandemic. Since then, wait times have further increased to an unprecedented 27.4 weeks in 2022, largely due to the cancellation and postponement of thousands of elective surgeries and treatments.

The result? At the beginning of 2023, at least 645,000 Canadians were waiting for surgery.

While pandemic-related cancellations were not unique to Canada, many of our international peers started in a much better place. For example, a Commonwealth Fund survey of 11 countries in 2016 revealed that Canada already ranked at the bottom of the pack for timely access to elective care. And in 2020, the first full year of the pandemic, Canada repeated this feat. Only 62 per cent of patients in Canada reported waiting less than four months for elective surgeries, far behind Sweden (71 per cent) the United Kingdom (72 per cent) and the Netherlands (87 per cent).

Fortunately, we can learn from these other countries that started in stronger positions and have now turned the tide on their surgical backlogs. Each of them have had their own struggle with wait times—and each have strategically addressed surgical backlogs when they occur.

First, these countries allow private-care providers to assume a more active role within the public system, thereby increasing available capacity and diminishing the pressure on public providers. While some Canadian provinces utilized private providers during COVID to help clear the backlog, and others have historically relied on private providers to delivery select procedures, the federal government is already threatening the provinces with financial penalties unless these clinics refrain from charging fees for private care.

Moreover, while patients in Canada are theoretically able to choose their specialists and surgeons, they’re essentially bound by referral decisions from their family doctor (if they have one). By contrast, these other universal health-care systems more actively allow patients to compare and choose providers—including (sometimes) private hospitals—for their publicly-funded treatments.

Finally, many countries that outperform Canada on wait times have shifted away from the sort of fixed hospital budgeting system used in Canada towards “activity-based” funding, which ensures that money follows the patient. When patients are no longer sources of expense in a fixed budget but rather a source of additional revenue, providers are encouraged to deliver quality services to attract more patients. This is in sharp contrast with the Canadian situation, where hospitals that accept referred patients do not get additional funding and have no incentive to treat patients in a timely manner.

Again, just about every universal health-care system in the world made the difficult decision to postpone (or cancel) medically necessary care during the pandemic. But countries such as the Netherlands, Sweden and the U.K. understand the importance of making better use of resources (whether public or private) to solve the crisis, financially incentivizing hospitals to treat patients in a timely manner, supporting universal access to care with the help of privately-owned care providers, and giving patients a choice when the public system fails.

It’s inconceivable that a rich and advanced country like ours would have its citizens languish on waiting lists for so long. There are important lessons to learn from these European countries, which have managed to reduce waiting times without undermining the principles of universality and equity in access to care. Let's hope for the sake of patients that Canadian policymakers draw inspiration from these countries rather than remain adamant on preserving our current broken health-care system.