Canada’s healthcare system has a number of important strengths. Most notably, it generally produces good medical outcomes for patients when compared to most other industrialized countries. For example, Canada’s cancer and heart attack survival rates are relatively high. Another plus is that our system provides universal access regardless of ability to pay.
But despite these strengths, Canada’s model also has some serious weaknesses, in particular, excessive wait times for treatment, especially in comparison to the high quality, universal healthcare systems found in Western Europe.
Weaknesses can be overcome.
Some Canadians believe it’s impossible to combat our system’s glaring weakness - long wait times - without compromising universality and quality. However, an examination of different European healthcare models reveals this is not the case. Several countries such as the Netherlands, Germany and Switzerland have universal healthcare systems where consumers have access to world-class healthcare without the long waits endured by Canadians.
For example, the average wait time for an MRI in Canada tends to be more than seven weeks. By contrast, the typical wait for similar diagnostic scans in top-performing European countries like Germany and Switzerland is less than one week. This delay can be the difference between life and death.
Similarly, waits for orthopaedic surgery are unconscionably long in this country. In France and the Netherlands, more than 90 per cent of hip and knee replacements are performed within 90 days of the decision to treat. But in Canada, the median wait time in many provinces is well over 100 days. In other words, even the people who wait the longest for surgery in Western Europe receive their treatments faster than the typical Canadian patient.
These short European wait times are achieved without compromising on quality. Top European countries like the Netherlands actually generate medical outcomes at least as good if not better than Canada’s. These impressive results are not a product of higher levels of spending; Canada spends more per capita on healthcare than most of Europe’s best systems including the Netherlands, Germany, Belgium and Denmark.
While Canadians suffer through long waits for necessary medical services, citizens of the “Tier 1” European countries enjoy access to prompt, high-quality care, despite comparable or lower levels of government spending. This achievement results from a fundamentally different approach to healthcare finance and delivery. The European model promotes consumer choice and competition by avoiding monopolistic government control over insurance and healthcare provision.
In many of the best European countries, universal coverage is guaranteed through a system that requires everyone to purchase comprehensive insurance from the provider of their choice. Financial assistance is provided to those without enough money. This ensures universal access to care while avoiding the inefficiencies created by a government monopoly, such as exists in Canada.
In the Netherlands, with perhaps the best healthcare system in the world, there is a robust private market for healthcare insurance and lively competition between healthcare providers, both for-profit firms and non-profits, to earn people’s business. Under Canada’s system of monopolistic government provision of care, and hospital budgeting that is not linked to productivity, there is no similar incentive for competition amongst providers. That’s why our system is inefficient and slow-moving compared to more competitive universal access systems like Holland’s.
Monopolies lead to inefficient resource allocations and low levels of productivity. Consumer choice and competition lower costs and boost productivity.
This is true in almost every area of economic activity, and it is true in healthcare. The empirical evidence from Europe proves this point. The evidence from Europe also shows that the efficiency-promoting forces of choice and competition can work effectively within the context of a universal system, resulting in reduced costs, greater efficiency and, most importantly, much shorter wait times.
Governments in Canada have generally shown little willingness to recognize the gravity of our system’s most serious flaw - long wait times for care - and thus have not embarked upon substantial reforms to shorten the queue. Small reforms around the edges will likely prove insufficient.
The monopolistic structure of our system must be fundamentally changed over time if we are to achieve the efficiency and consumer responsiveness of Western Europe’s universal systems. In particular, we should begin to imitate the best practices of European countries like Denmark, Germany, France and the Netherlands.
Ben Eisen is a policy analyst with the Frontier Centre for Public Policy and a co- author of the Euro-Canada Health Consumer Index 2010.
