Why do other universal health-care countries have shorter wait times than Canada?
A recent study by the Fraser Institute estimates that 894,449 Canadians waited 9.8 weeks (on average) for treatment after seeing a specialist, resulting in an average personal cost of $1,304 in lost productivity and income—which adds up to a $1.2 billion loss for the Canadian economy.
And this is surely a conservative estimate, since it does not account for time Canadians spend waiting in a reduced capacity outside of the typical work week. (Valuing all hours of the week—including evenings and weekends, but excluding eight hours of sleep—the cost estimate increases to $3.5 billion or $3,951 per patient.) Nor does it factor in the 8.5 week wait to see a specialist in the first place, the cost of care provided by family members and friends, or the risk of disability, adverse medical consequences, and in the worst cases, death.
Some may argue these figures are simply the price Canadians must pay for universal health care. Not true.
Several other countries including Australia, France, Germany, the Netherlands, Sweden and Switzerland, ensure universal health care for about the same cost as Canada (measured as a percentage of the economy, and adjusted for age) but with remarkably shorter wait times.
There are three key differences in the way these countries finance and deliver universal health care. First, they generally allow private companies to operate in either the insurance or hospital sectors—stimulating competition, increasing capacity, and providing an alternative when the public system fails.
Second, each of these countries expects patients to share in the cost of treatment, thereby encouraging the responsible use of scarce health-care resources. Of course, in order to avoid undue financial burden, there are usually annual limits on such payments, and vulnerable groups (the elderly, the chronically ill, pregnant mothers) are usually exempt.
Finally, hospitals in these countries are more commonly financed through a system of activity-based funding instead of global budgets. As a result, hospitals are incentivized to treat more patients and compete for funding, instead of simply staying within a budget determined by government.
It is unlikely that any one of these policies will, on their own, definitively solve Canada’s wait times problem—rather, patients, health-care workers, taxpayers and policymakers will have to decide what combination of the three works best in a Canadian context.
However, based on the experiences of other countries, it is clear that there are a multitude of policy options available to help ensure more timely treatment for patients in Canada without sacrificing the universal nature of our health-care system.
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