Waiting for health-care reform
As Democratic presidential candidates endorse a consciously Canadian-style “Medicare for All” plan, it’s a good time to ask if Canada itself is using the right model. After all, there are many universal systems across the developed world and most have managed to avoid Canada’s long wait times, outdated equipment, and “hallway medicine.” These successful systems’ main difference with Canada: allowing the private sector to pitch in.
The Commonwealth Fund surveyed waits for elective surgery in the past two years. Only three per cent of American patients had waited four months, compared with 18 per cent in Canada. Those universal systems that, unlike ours, do maintain a strong role for private insurance recorded U.S.-style numbers: In Switzerland, only six per cent of patients had waited four months or longer, in the Netherlands just four per cent and in Germany zero per cent. Z-e-r-o.
Such numbers suggest it is possible to eliminate waiting times while providing quality care and maintaining universal coverage. But despite decades of fierce public debate and escalating budgets, Canadian wait times actually continue to get worse. From referral to a specialist to consultation and then to actual treatment now takes an average of 20.9 weeks, in addition to the original wait to see the family doctor in the first place — this for “medically necessary” treatment.
As a result, by one estimate, at any given moment, over one million Canadians — three per cent of the entire population — are waiting for a medical treatment.
The shortages ripple through the system. One Ontario doctor called in a referral to the local hospital only to be told there was a 4½-year wait to see a neurologist. One 16-year-old boy in British Columbia waited three years for “urgent” surgery, during which time his condition deteriorated so much that he became a paraplegic. In Montreal, a man was finally called for his surgery for a severe heart problem — three months after he had died.
With so much waiting going on it’s not surprising that Canadians made 217,500 trips abroad for health care in 2017 alone, paying outof-pocket to skip the wait. As one Albertan put it, even $25,000 out-of-pocket is worth it for an entire year of living without severe pain.
Beyond rationing care by waiting list, Canada’s monopoly health care also underinvests in equipment and staff. Canada has 35 per cent fewer acute care beds and one-fourth as many MRIs per capita as the U.S. — indeed, it has fewer MRIs per capita than Turkey, Chile or Latvia. As a result, Canadian MRI waits average over nine weeks, adding months of diagnostic delays on top of the months of treatment delays. Even routine exams like ultrasounds have almost four-week waiting lists.
Some treatments are simply unavailable to Canadians. When it comes to new pharmaceuticals, for example, Canada’s policy of forcing down prices has contributed to years-long delays during which Canadian patients must make do with older drugs that might be less effective or have harmful side effects.
According to the OECD, Canada ranks 29th out of 33 high-income countries in terms of doctors per 1,000 population. The shortage of specialist doctors is particularly acute, with Canada having only half as many per capita as the U.S. Between shortages and waiting lists, Canadian emergency rooms are packed. According to the Commonwealth Fund, 29 per cent of Canadian adults reported wait times of over four hours, nearly three times the U.S. level (11 per cent) and more than in other industrialized countries, too. Many Canadian ER visitors end up leaving without ever being treated, giving up on a medical system that’s “free” but also perennially “out of stock at the moment.”
In sum, Canada’s public health-care monopoly achieves cost savings by rationing care with waiting lists, skimping on equipment and facilities, using older drugs, and underinvesting in medical staff to the point of nationwide shortages. It is Canadian patients who pay the price.
It’s well past time to move beyond the false choice between universality and a U.S.-style system. Successful European systems show that bringing in the private sector can lead to shorter wait times and high-quality, responsive care for all citizens.
As for Americans, while they are right to reform their medical system, which though very expensive delivers mediocre results in some areas, they might want to think twice before choosing Canada as a model.
Peter St. Onge est économiste senior à l’IEDM, Patrick Déry, analyste associé senior à l’IEDM. Ils sont les auteurs de « Les misères du système de santé canadien : listes d’attente, équipement désuet et pénuries de personnel » et signent ce texte à titre personnel.