In Canada, ‘the doctor will NOT see you now’ — and it’s a problem

For Canadians, the promise of accessible, “free” health care is inextricably linked to our identity. The commitment to offering every Canadian, regardless of ability to pay, high-quality treatment was long a source of national pride. However, for some time now, our inability to deliver on this promise has become a source of national shame, and of widespread suffering.

In 2023, fully 14 per cent of Canadians did not have regular access to a primary care provider. Even for those lucky enough to have a family doctor or nurse practitioner, the prospect of receiving timely care is remote, with only 26 per cent being able to secure same- or next-day appointments.

We can no longer pretend that a chronic lack of access to primary care is not the defining feature of Canadian health care.

This lack of timely access creates ripple effects throughout the system. Last year, it translated into nearly 1,000,000 avoidable emergency room visits. Navigating our health system means confronting one bottleneck after another.

However, this is not true of all countries that have universal healthcare systems. And it is partly the result a particular flavour of Canadian squeamishness about allowing more flexibility and dynamism into our system.

Take Germany and the Netherlands; both countries provide universal health care to their populations, but they boast better patient outcomes than Canada does.

For example, nearly all German and Dutch residents have access to a primary care provider, and more than half are able to get an appointment the same or the next day.

In the 2024 Commonwealth Fund rankings on healthcare access, Canada placed seventh out of 10 countries, while Germany ranked third and the Netherlands took first place.

Many imagine that the solution is for governments simply to increase health spending, but Canada is among the biggest spenders in the OECD when it comes to health care—and Alberta’s spending is among the highest in Canada.

As a share of its economy, Canada spends roughly as much as Germany and a bit more than the Netherlands on health care. Alberta spends $9,370 per person, slightly more than our national average.

Fixing Canadian health care means acknowledging that a universal system can include private as well as public providers.

If spending were the issue, we would have kicked this problem years ago.

Governments have a moral responsibility to inform themselves about what these countries do differently to achieve better results. Three elements in particular stand out.

First, Germany and the Netherlands have multi-payer systems, with competition among insurers. Both countries allow patients to choose and switch health insurers annually, encouraging quality and adaptability in health service delivery​.

Second, unlike Canada’s strict public system, Germany and the Netherlands prioritize patient and professional choice. They allow healthcare professionals to practise in both the public and the private sectors. This increases flexibility for providers, and access for patients.

Third, gaining access to specialists isn’t as daunting in Germany and the Netherlands as it is in Canada. In those countries, it is possible for patients to see a specialist without a mandatory referral. This eases the burden on primary care providers and substantially streamlines care.

All of this culminates in a mixed healthcare model that empowers patients by offering them more choice while incorporating independent actors to enhance access. The cherry on top? Universality remains pristine and untouched.

Successful examples abroad demonstrate that universal care does not have to mean government care; instead, it means providing patients with the right care at the right time. Clinging dogmatically to the government monopoly model has endangered countless Canadian lives.

What staunch defenders of the public system leave out of the conversation is the fact that care delayed is care denied. For patients with chronic illnesses, pain management issues, or mental health concerns, the burden of waiting exacerbates their suffering and diminishes their quality of life.

Universality shouldn’t just be hypothetical; it should be a reality. Adopting new solutions and new approaches is the only way we can once again be proud of our healthcare systems. Let’s start by buying our policymakers a dictionary and teaching them that “universal” and “public” are not synonyms.

Krystle Wittevrongel is Director of Research at the MEI. The views reflected in this opinion piece are her own.