WESTERN STANDARD COLUMN: Canadians Staying Home Over Waitlist Fears

Millions of Canadians are currently waiting for surgery, a diagnostic scan or an appointment with a specialist; the number is currently estimated to be about one in eight Canadians. 

While the personal story of the patient suffering behind these numbers is often heartbreaking — chronic pain, lost time with loved ones and even death — the good news is the public is ready for reform, and there are options that could help patients immediately.

And just as well… it’s no surprise that Canadian patients are facing the longest recorded wait times since the Fraser Institute began tracking that data 30 years ago. 

On average, Canadians are waiting for more than half a year before they can get the care they need. These waits have very real consequences for patients. 

A growing number of Canadians are turning away from the health care system altogether. According to new polling data released by SecondStreet.org, 47 per cent — nearly half — of Canadians are choosing to stay home rather than access Canadian health care services. 

While that number on its own should bring a pause to governments across Canada, it’s even more heartbreaking when we apply the data SecondStreet.org collects. If we know more than 60,000 patients died in Canada while waiting for care, what does that mean for patients who never sought treatment at all? 

It’s impossible to know, but it is damning that it’s happening at all. It’s no wonder then, why nearly three in four Canadians support following the example of the European Union, and giving more choice to patients through a policy called the Cross Border Directive

In Europe, patients have the right to travel to another EU country, pay for surgery and then be reimbursed by their home government. Reimbursements cover up to the same amount their home government would have paid to provide care locally. This policy brings together the health resources of the continent, and opens new pathways for patients to get the care they need if local wait times happen to be long.  

This means that if patients can find a provider that can perform the treatment for the same or a lower cost, it would be entirely covered by their own government. If they went to a jurisdiction where it may cost more, they would not have to bear the full cost of that treatment out of pocket. 

Even better news for provincial policy makers: this policy would already comply with the Canada Health Act, and has been utilized by some governments on occasion, often for one-off procedures they cannot perform. Shockingly, an Ontario court ruled earlier this year that taxpayers were on the hook to send an individual to a private clinic in Texas to have an artificial vagina installed behind a functioning penis. Why they won’t do the same for patients waiting months for knee or hip replacements is quite frankly bizarre. 

In practice, the Cross Border Directive means lower wait times and better access to care, which is true of nearly every universal health care system across Europe. However, many Canadians would suggest they are uneasy about the idea of paying out of pocket for health services, but when faced with a lack of access to the care they need, they are already making that choice. Eleven per cent of Canadians are already choosing to pay out of pocket for private health services. 

Even more interesting is that number remained similar across all incomes — with 9 percent of the lowest earners still finding a way to put their own health first. If patients had access to rebates from their governments for those services, imagine how many more people could access care when Canada’s government-run system couldn’t provide it. 

At the very least, it might be worth exploring a pilot where a few procedures could qualify for such a program, like the hip and knee replacements which face a significant backlog across Canada. 

It’s certainly better than allowing even more Canadians to lose faith in our own health care system. 

Harrison Fleming is the Legislative and Policy Director for SecondStreet.org, a Canadian Think Tank. 

This column was originally published in The Western Standard on November 7, 2024.

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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.