TORONTO SUN COLUMN: Canada’s Failing Health Care System Needs Reform

We’ve come a long way from “Canada has the best health-care system in the world” — a common claim in this country 20 years ago.

Now you would be hard-pressed to find anyone who shares those words without injecting sarcasm. Despite record spending in health care, the system is failing right across the country. Stories about patient suffering are everywhere — only serious health reform will improve outcomes.

Last year, Vancouver patient Allison Ducluzeau was told she had as little as two months to live while battling cancer. The government told her there was nothing it could do to help her, but did offer her medical assistance in dying (MAiD). Ducluzeau refused to accept her death sentence. She went to the U.S., paid for treatment and recently celebrated her marriage in Hawaii.

In Saskatchewan, patient Jolene Van Alstine has been living with chronic pain for six years and was told it could be another two years before she receives surgery. Van Alstine has contemplated applying for MAiD.

Some readers may remember cancer patient Laura Hillier’s call for help that went viral back in 2016. The 18-year-old Ontario patient had a bone marrow donor lined up but passed away after waiting seven months for a bed and a surgeon to become available.

More recently, Ontario patient Shannon Anderson died in 2021 after being forced to wait too long for a heart operation. She left behind four children. Incredibly, the local hospital called to schedule her surgery a few days after she had died.

Some will claim these are anecdotes, so consider this figure. Ontario Health data obtained by SecondStreet.org shows that 931 patients have died in Ontario while waiting for heart surgery since 2013. Of those, 244 died after waiting longer than the maximum recommended wait time.

In Nova Scotia, government data shows that 50 patients died last year while waiting for surgeries that could have potentially saved their lives. Of those, 19 had waited longer than the maximum recommended wait time.

While the system is well-funded and has many well-meaning doctors and nurses, the structure itself is broken. Other countries operate universal health-care systems that regularly outperform Canada.  How do they do it?

For one, patients in virtually every other country are not forced — by law — to wait for government care. They are given a choice between government care or private options. This takes the pressure off the public system every time a patient decides to pay for private surgery. Canada would be wise to follow suit.

Other better-performing systems also partner with private clinics or private companies if it makes sense. For instance, Sweden has a government-owned hospital that is managed by a private company. It delivers exceptional care for 30% less than nearby government-run hospitals. The savings allow the system to treat more patients.

Governments in other countries also deliver better care by funding hospitals based on their output instead of just cutting cheques each year and hoping for the best. If Canada did that, hospitals would focus more on patient care and reduce inefficiencies, such as losing millions by running Tim Hortons stands.

One thing is clear. It’s time for health reform in Canada. Decades of throwing money at the system and hoping for the best clearly hasn’t worked.

Colin Craig is president of SecondStreet.org, a Canadian think tank 

This column was originally published on December 7, 2023.

Share on Facebook
Share on Twitter

You can help us continue to research and tell stories about this issue by making a donation or sharing this content with your friends. Be sure to sign up for our updates too!

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.