If Canada’s health system allowed more competition and made funding follow the patient, it could improve health care, suggests a new report by the Fraser Institute, a non-profit think tank.
“The level of health resources was—and still is—among the lowest in the developed world, despite public spending among the highest per capita,” said the report. Over the past 30 years, the data collected “reveals a steady deterioration in access” to elective surgeries, it said.
“International data suggests that for many years Canadians have endured some of the longest delays in the developed world while they wait for access to medically necessary care.”
In Canada, 62 percent of patients reported that they waited less than four months for elective surgery. In Sweden, where there is competition in health-care delivery, money follows the patient, and additional capacity is provided through private health care professionals, 71 percent of patients wait less than four months for surgery. That goes up to 72 percent in the United Kingdom, and 87 percent in the Netherlands. In other words, in the Netherlands, only 13 percent of patients have to wait more than four months for medically needed procedures.
The report noted that provinces typically increase public funding, temporarily increasing the capacity of the health system in specific areas, but not solving “the problems at the root of long waiting lists for care.”
Europe
According to the report, hospitals in other countries with universal health care, such as England, the Netherlands, and Sweden, have moved away from a centrally planned system where the government is in charge of financing and delivering services.“These countries have sought to provide better incentives to care providers, separating the role of purchaser from that of provider of services, while at the same time regulating and monitoring the quality of care provided,” said the report.
It suggested that allowing freedom of choice for patients, competition from both public and private health care providers, as well as making “money follow patients” are some of the policy tactics that have been used by other countries to improve access and efficiency.
“By making patients no longer a source of expenses in a fixed budget but rather a source of additional revenue, patient-based funding schemes encourage providers to deliver quality services in order to attract patients and treat them in a timely fashion,” said the report.
According to the Fraser Institute, European countries have allowed private health care providers to take a more active role, which it said increases capacity and reduces pressure on the public system.
The report said if private providers provide more elective surgeries and make optimal use of operating-room capacity, more surgeries can be performed overall. It defined elective surgeries as scheduled procedures that are all medically necessary, and includes treatments such as cataract removal, cancer surgery, and coronary bypass surgery.
The report cited SecondStreet.org data that indicates the waiting list for surgical treatment has grown since COVID began. According to data obtained, at least 645,000 Canadians were waiting for surgery across Canada (excluding the provinces of Manitoba and Nova Scotia) at the beginning of 2023.
Ontario presently has the largest backlog of elective surgeries, as well as a large population, with almost 206,000 patients on the waiting list.
The report noted that Quebec, as of the end of January 2023, had more than 160,000 patients on the waiting list for a planned surgery, of which nearly 55,000 had been waiting for more than six months.
“Over the decades, despite promises and numerous reforms by successive governments to tackle this chronic problem once and for all, long waiting times have become a characteristic feature of Canadian health-care systems,” said the report.
