Paying the Ultimate Price for Single-Payer Health Care
There are many ways to examine the price we pay for Canadian health care. Economists (myself included) are often predisposed to defaulting to statistics summarizing the amount of health care dollars spent per person ($9,054) or as a portion of our economy (12.4 percent). However, there are other costs that we don’t see as readily – notably, the personal costs paid for our collective commitment to the failing single-payer health care model.
Consider the story of Joan Hama. The Kelowna woman’s doctors recommended that she receive a colonoscopy after going through a cancer screening. The recommended wait time? Eight weeks. She waited twice that time… and then her colon ruptured, nearly killing her. This near-death experience could have been avoided, had she simply received the diagnostic and subsequent treatment on time.
Unfortunately, for some patients, it’s even worse. New government data released by SecondStreet.org revealed that Joan isn’t alone – 1,586 patients in B.C.’s Interior Health region paid the ultimate price and died while waiting for treatment just this past year.
Of these, just under 15 percent died waiting for surgical treatments while the majority (over 85 percent) died waiting for a diagnostic scan. The latter should not be dismissed, as diagnostic imaging is a critical tool to help determine the severity of a patient’s condition and find out how urgently they need care..
Unsurprisingly, almost 40 percent of patients who died while waiting for surgical or diagnostic procedures had been waiting over the government’s own priority wait time target.
Again, that’s just in one region of one province. In 2023-24, B.C. saw 4,516 total waitlist deaths. Across Canada, it was 15,474. If the Kelowna area is an indicator, that number will continue to rise.
So, what’s to be done?
First, patients must be informed when they won’t get care in time. This is exactly why SecondStreet.org and a deceased patient’s family recently suggested Debbie’s Law, which would legally require health regions to tell patients if wait times for life-saving treatment exceed guidelines. This would arm patients with the knowledge that their life was at-risk and some might consider options outside the province.
Second, patients must be given an alternative. If governments are unable to provide medical or diagnostic care in a timely manner, they should be allowed to pay for care at non-government health providers. Unfortunately, provincial governments across Canada (with the exception of Quebec) have chosen to do the opposite. Together, the former BC Liberal party and NDP spent more than a decade battling the Cambie Surgery Clinic’s fight to provide private health care to patients failed by the public system. The result was a win for governments and the status-quo, and a loss for Cambie and the patients suffering on waitlists.
Finally, provincial governments should introduce reforms to cut waste and incentivize care. Hospitals in BC (and across most of Canada) are funded using an opaque and outdated method of funding called global budgets. Basically, hospitals are allocated a budget based on historical trends and then asked to do their best within that constraint. This method of funding is disconnected from the real-time demand for services, and treats patients like a cost – chipping away at the pre-defined budget. But there’s a better way. Research by the Montreal Economic Institute, CD Howe, Fraser Institute and others (including the author of this column) have pointed out that other universal health care countries around the world – particularly those with shorter wait times like Switzerland, the Netherlands and Germany – use a system called activity-based funding . This method of funding ensures money follows the patient and actually incentivizes care. Simply put, under this system, hospitals would be actively paid for the type and complexity of procedures needed by the 1,586 who died last year – there would be no need to force them to wait.
The failures of Canadian health care are more obvious than ever before. We don’t need to sacrifice our commitment to universal health care in order to fix it. And patients shouldn’t have to sacrifice their lives to preserve it.
It’s time to take a prudent approach that takes the best lessons from other countries that do a better job, while allowing patients to get the care they need until we get our house – or rather, hospitals – back in order.
Bacchus Barua is the Research Director for SecondStreet.org, a Canadian think tank.
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