Nadeem Esmail
Waiting is a defining characteristic of Canadian healthcare.
Delays in accessing medical care in Canada can be remarkably long. In 2012, for example, the average Canadian could expect to wait more than four months for treatment by a specialist after their general practitioner has referred them. Despite substantial increases in taxpayer-funded health expenditures and numerous governmental initiatives to reduce delays, wait times have improved little over the past decade. These delays cost Canadians as much as $3 billion in lost time and lost productivity that year.
Some, such as John Hirdes, a professor at the University of Waterloo’s School of Public Health and Health Systems, suggest the only alternative to waiting is more government spending and/or the abandonment of universality. But such claims entirely ignore reality: Other nations avoid waiting without increasing spending or depriving people of healthcare. If they can do it, so can we.
Contrary to popular belief, Canada’s terrible wait times are not the result of insufficient healthcare spending.
Canada’s wait times are among the longest in the developed world. For example, the Commonwealth Fund’s international health policy survey has found Canadians endure longer waits for access to emergency care, primary care, specialist care, and elective surgery than patients in Australia, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the U.K., and the U.S. Note that nine of those 10 countries maintain universal approaches to healthcare insurance. (The U.S., though moving in that direction, is still the exception.)
And, contrary to popular belief, Canada’s terrible wait times are not the result of insufficient healthcare spending. In 2009 (the most recent year for which comparable statistics are available), Canada’s healthcare system ranked as the developed world’s most expensive universal access system. After adjusting for the age distribution of different populations (older people require more care), Canada spent 12.5% of GDP on healthcare, compared with a universal-access-nation average of 9.9% and as little as 6.7% in Japan. Not only did Canadians wait longer than their counterparts in other developed nations with universal access health insurance systems, they spent more for the dubious privilege of doing so.
Clearly the argument that Canada can only reduce waiting through increased health spending and/or abandoning universality is, at best, incorrect. The solution to Canada’s wait-time woes is sensible health policy reform based on the approaches pursued in the developed world’s highest performing universal access health insurance programs.
Belgium, France, Germany, Japan, Luxembourg, the Netherlands, and Switzerland all share Canada’s noble goal of ensuring access to care regardless of ability to pay. Those countries, however, deliver that care without lengthy queues for treatment. Further, both Switzerland and Japan are recognized as providing some of the best healthcare outcomes in the developed world.
How do they do it?
- All these other nations employ private competition in the delivery of universally accessible hospital and surgical services.
- All have private parallel healthcare sectors.
- All require those seeking universal care to share in its cost through co-payments or deductibles.
- Finally, all employ a social insurance model of funding, where an independent authority (or private competitive insurer) oversees the daily operation and financing of the health insurance scheme. Governments are still involved as they should be, in a regulatory and oversight role.
Don’t be misled by fear-mongers and their “privatization” and “profit” bogeymen: None of the nations listed above abandoned universality as a result of their more effective policy approaches. They all ensure access to care regardless of ability to pay. And they actually deliver on the promise of timely access to high-quality care regardless of medical history or ability to pay. They stand in stark contrast to Canada’s provincial governments, which break that promise daily (most often to those in the lowest socio-economic classes).
We do not need to spend more money or kick people off of healthcare to fix Canada’s scandalously long wait times. Sensible policy reform, based on the approaches employed in the world’s leading universal health insurance systems, can solve our wait-time problem, helping Canadians to live healthier, more productive lives.
Nadeem Esmail is director of health policy research at the Fraser Institute. Follow him on Twitter @nadeemesmail. This column has been reposted with the permission of Troy Media.
