Health care in British Columbia: The big picture

Random numbers forming a sphere on the woman's hand

Jenny Mckenzie, Bruce MacDonald and countless others in Canada have been told they would have to wait years for surgery in the public health care system.

While their stories are anecdotes, we know they are putting real faces and names to a very large problem – a health care system that is struggling with long waiting lists.

And when government programs struggle, some politicians and special interest groups inevitably suggest the solution is simply for the government to spend even more money.

But is that really the answer to our health care system’s woes?

No.

Consider a few big picture numbers from British Columbia.

In 2019, the B.C. Anesthesiologists’ Society released a report with figures on B.C.’s population and waiting list data:

Population:

2001/02  –  4,100,000
2017/18  –  4,800,000 (up 18.2%)

Patients waiting for surgery:

2001/02  –  55,367
2017/18  –  85,468 (up 54.4%)

In short, the province’s population is up a bit, yet waiting lists have grown more than twice as fast. With these figures in mind, we looked at government spending in B.C. on health care.

If we are to believe an increase in spending will increase services then surely the decrease in service levels can be explained by a decrease in spending … right?

That’s not the case.

If you look at “Table F” from the Canadian Institute for Health Information, you’ll find spending exploded during the same period:

B.C. government health care spending:

2001/02  –  $10.380 billion
2017/18  –  $20.255 billion (
up 95%)

B.C. government per capita health care spending:

2001/02  –  $2,537.42
2017/18  –  $4,183.96 (
up 65%)

According to the Bank of Canada’s inflation calculator, Canada’s inflation rate was about 34% during this period. B.C.’s inflation rate may differ a bit, but inflation is not likely to be the culprit of growing waiting lists.

If we compare Canada’s health care system with other nations, the data suggests we’re just not getting very good bang for our buck.

This 2017 report (click here) from the progressive Commonwealth Fund shows that Norway, the United Kingdom, Australia and New Zealand are all performing much better than Canada, while spending less. See this chart from the report:


This obviously brings us to the question of ­– what do we need to do to improve outcomes for patients?

As we noted in our recent policy brief The flight of the sick, we sat down with the Fraser institute’s Bacchus Barrua to discuss health care reform and what needs to be done.

Barrua described three common features among countries that are achieving better results with their universal health care systems (Germany, Switzerland, France, the Netherlands, Australia, Sweden):

  1. They have a different attitude towards the private sector – Rather than seeing the private sector as the enemy, they see the private sector as a partner to help deliver services. (Including as a pressure valve that helps reduce demand on the public system).
  1. Patients share in the cost of treatment – Patients are required to contribute to the cost of services in an affordable manner (with limits to ensure no one has to choose between health care and their mortgage). This approach helps ensure patients think of health care as a service that should be used wisely. 
  1. These countries fund their hospitals differently – Most hospitals in Canada are funded through a “global budget” that is set at the beginning of the year and then spent. More effective health care models fund hospitals based on productivity so there is an incentive to provide better, higher quality care with better results for patients.

Colin Craig is the President of SecondStreet.org

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Prevention – reduce demand in the first place

If Canadians lived healthier lives, we could reduce demand for emergency services, orthopaedic surgeries, primary care and more. 

For instance, if you visit the Canadian Cancer Society’s website, you’ll read that “about four in ten” cancer cases are preventable. The Heart and Stroke Foundation notes that “almost 80 percent of premature heart disease and stroke can be prevented through healthy behaviours.” A similar number of Diabetes cases are also preventable. 

Many joint replacements and visits to ERs and walk-in clinics could also be avoided through healthy living. 

To be sure, not all health problems can be avoided through healthy living – everyday the system treats Canadians with genetic conditions, helps those injured in unavoidable accidents and more.  

But there is an opportunity to reduce pressure on the health care system through Canadians shifting to healthier lifestyles – better diets, more exercise, etc. 

To learn more, watch our Health Reform Now documentary (scroll up) or see this column. 

Partner with non-profits and for-profit clinics

European countries will partner with anyone who can help patients. 

It doesn’t matter if it’s a non-profit, a government entity or a private clinic. What matters is that patients receive quality treatment, in a timely manner and for a competitive price.  

In Canada, governments often delivery services using government-run hospitals instead of seeing if non-profit or private clinics could deliver the services more effectively. 

When governments have partnered with non-profit and private clinics, the results have often been quite good – Saskatchewan, Ontario and British Columbia are just a few examples of where partnerships have worked well. 

Canada should pursue more of these partnerships to reduce wait times and increase the volume of services provided to patients.  

To learn more, watch our Health Reform Now documentary (scroll up) or see the links above. 

Make cross border care more accessible

In Canada, citizens pay high taxes each year and we’re promised universal health care services in return. The problem is, wait times are often extremely long in our health system – sometimes patients have to wait years to see a specialist or receive surgery. 

If patients don’t want to wait long periods, they often have to reach into their own pocket and pay for treatment outside the province or country. 

Throughout the European Union, we also find universal health care systems. But a key difference is that EU patients have the right to go to other EU countries, pay for surgery and then be reimbursed by their home government. Reimbursements cover up to what the patient’s home government would have spent to provide the treatment locally. 

If Canada copied this approach, a patient waiting a year to get their hip operation could instead receive treatment next week in one of thousands of surgical clinics throughout the developed world. 

Governments benefit too as the patient is now back on their feet and avoiding complications that sometimes come with long wait times – meaning the government doesn’t have to treat those complications on top of the initial health problem. 

To learn more, watch our Health Reform Now documentary (scroll up) or this shorter video. 

Legalize access to non-government providers

Canada is the only country in the world that puts up barriers, or outright bans patients from paying for health services locally. 

For instance, a patient in Toronto cannot pay for a hip operation at a private clinic in Toronto. Their only option is to wait for the government to eventually provide treatment or leave the province and pay elsewhere. 

Countries with better-performing universal health care systems do not have such bans. They allow patients a choice – use the public system or pay privately for treatment. Sweden, France, Australia and more – they all allow choice. 

Why? One reason is that allowing choice means some patients will decide to pay privately. This takes pressure off the public system. For instance, in Sweden, 87% of patients use the public system, but 13% purchase private health insurance. 

Ultimately, more choice improves access for patients. 

To learn more, watch our Health Reform Now documentary (scroll up) or watch this short clip on this topic. 

Shift to funding services for patients, not bureaucracies

In Canada, most hospitals receive a cheque from the government each year and are then asked to do their best to help patients. This approach is known as “block funding”. 

Under this model, a patient walking in the door represents a drain on the hospital’s budget. Over the course of a year, hospital administrators have to make sure the budget stretches out so services are rationed. This is why you might have to wait until next year or the year after for a hip operation, knee operation, etc. 

In better-performing universal health systems, they take the opposite approach – hospitals receive money from the government each time they help a patient. If a hospital completes a knee operation, it might receive, say, $10,000. If it completes a knee operation on another patient, it receives another $10,000. 

This model incentivizes hospitals to help more patients – to help more patients with knee operations, cataract surgery, etc. This approach also incentivizes hospitals to spend money on expenses that help patients (e.g. more doctors, nurses, equipment, etc.) rather than using the money on expenses that don’t help patients (e.g. more admin staff). 

To learn more about this policy option, please watch our Health Reform Now documentary (scroll up) or see this post by MEI.