After the last presidential debate, many observers questioned the veracity of Donald Trump’s claim that Canadians “come into the United States in many cases because their system is so slow. It's catastrophic in certain ways.”

Our latest study provides some answers. While we weren’t able to track the exact number of Canadian patients travelling to the U.S. for treatment, we calculated an estimate for the number of patients who leave the country for treatment.

Here’s how we did it.

The Fraser Institute's annual survey of medical waiting lists asks physicians in 12 major medical specialties what percentage of their patients received non-emergency medical treatment outside Canada in the preceding year. Combining these percentages with data on the number of procedures performed in Canada from the Canadian Institute for Health Information suggests that an estimated 45,619 Canadians have received treatment outside the country in 2015.

While we cannot draw a clear link between the reasons why, one explanation may be the long wait times Canadians face for medical treatment. Last year, patients faced an estimated average wait of 18.3 weeks between referral from a family doctor to receipt of medically necessary elective treatment—almost twice as long as the 9.3 weeks in 1993.

Further, if we solely examine the wait between specialist consultation to treatment, physicians report that patients wait almost three weeks longer than what they consider to be clinically reasonable.

And here’s the crucial point. Long wait times, with their potential negative effects on the health and wellbeing of Canadians, are not a necessary characteristic of universal health care. Australia, France, Germany, the Netherlands, Switzerland and Sweden all maintain universal health-care systems and spend about as much as we do on health care, but don’t have the long wait times Canadians endure.

The difference lies in the way those other countries structure their systems. They generally allow the private sector to play a role (either as a partner or alternative), require patients to share in the cost of treatment (with annual caps, and exemptions for vulnerable populations), and generally fund their hospitals according to activity (unlike Canada, where most hospitals are bound by global budgets).
    
While Canadians will have to ultimately decide which mix of these policies will work in a Canadian context, it’s clear that simply throwing money at the wait-time problem without addressing the root cause is not the answer.

While Mr. Trump’s characterization of Canada’s health-care system as “catastrophic” may be a case of political hyperbole, we cannot ignore the very real issues that plague our system. We rank among the top spenders in the world when it comes to health care, and yet have fewer physicians and beds per person than the average OECD country and some of the longest wait times in the developed world.

It’s time to acknowledge the challenges we face in our health-care system, and consider policy options that may help deliver universal care in a more timely and effective manner.