There is no longer any humour in the barb that Canada’s Healthcare System is a health “wait-for-care” system.
Canadian politicians of all stripes seem averse to addressing the country’s foundational healthcare problems head-on. For years they have been dragging their feet, kicking foundational health care problems down the road a little bit further so that the critical issues of accessibility and sustainability will be another government’s problem to solve. But their failings are becoming clearer and more politically painful as time goes on with the multiple reports and studies documenting how Canada is falling behind international peers with respect to access to care -- and that prolonged wait times are resulting in deaths.
Alarmingly, it is reported that over 74,000 Canadians have died on wait lists since 2018 and, according to SecondStreet.org, at least 15,474 patients died in 2023-24 waiting for surgery or a diagnostic scan. That number is likely double given the data is incomplete or simply not tracked in hospitals across our country. Wait times are growing for priority procedures such as hip replacements and cancer surgeries according to CIHI, and data from Ontario Health suggests 378 patients died while waiting for cardiac surgery or a cardiac procedure in that province alone.
It is not just the delays for surgeries and diagnostics that are putting Canadians at risk. Millions of Canadians are without a family doctor. Recently, hundreds of people lined up in a small town in Ontario braving winter weather hoping to sign up for a family doctor with the first 500 in line being accepted. It is reported that some of those residents have been without a family doctor for ten years.
All this while Canada is one of the countries with the highest health spending at $372 billion in 2024, without an overall vision of what health care in the future will look like.
A large part of the problem is that politicians tend to create reactive policy rather than be forward looking with consideration of scientific and technological advancements. Government’s common approaches include tweaking of health human resource numbers, adjustment of scopes of practice, and a bolus of funding for new hospitals or other legacy institutions. Sometimes there is a multi-billion-dollar federal funding drop to take the heat off for awhile. However, federal government actions (or lack of actions) can create very significant consequences that result in serious ramifications to provincial budgets and to the people impacted negatively in the healthcare system. When one area of healthcare expands, it should be expected that another area will contract.
Take for example federal Health Minister Mark Holland’s recent interpretation letter that “physician-equivalent services” provided by nurse practitioners, pharmacists, and midwives should be covered by provincial and territorial publicly funded health insurance programs such as OHIP. At a fundamental level, Minister Holland’s letter expands the Canada Health Act (CHA) by stealth. The CHA is clear on physician services and hospital services being funded publicly and leaves the law of the provinces to determine how other health care providers could be funded. Minister Holland has opened the door to changing this with just a letter.
It is doubtful that the CHA was intended to include this breadth of change driven by a simple letter, but it raises issues surrounding the future sustainability of our healthcare system in its current form and the mechanisms by which change should occur. There is a real possibility that Minister Holland may have inadvertently contributed to the end of family physicians, the most productive primary healthcare providers. The implications of this would be a disaster for primary care access and a more thoughtful approach from the provinces and territories is required before 2026.
In a Globe and Mail opinion piece “Does the Canada Health Act require reinterpretation, or a more fundamental rethink?”, Andre Picard points out that:
“The Canada Health Act does not prohibit duplicate private insurance, or any private provision of care for that matter. What the law is supposed to do is help ensure the fundamental philosophy of medicare-that no one is denied essential care because of an inability to pay-is respected.”
And,
“At some point, federal, provincial and territorial legislators-and Canadians more broadly-will have to determine the place of private insurance in our largely publicly funded system. Every health system in the world has a mix of publicly and privately insured care. Getting the mix right to ensure fairness and equity in access is ultimately what matters.”
In the recent C.D. Howe Institute report, “Troubling Diagnosis: Comparing Canada’s Healthcare with International Peers”, the message is stark, “All Canadian provinces and territories fall below the international average for overall healthcare performance...”. The report states: “In international comparisons with its peers, Canada ranks ninth out of 10 countries, performing below the international average in access to care, administrative efficiency and equity – and ranking last in timeliness. For those who can access care, the quality of care is relatively high.”
In a recently published Fraser Institute report, “Waiting Your Turn: Wait Times for Healthcare in Canada, 2024 Report”, Canada’s median healthcare wait time hits 30 weeks, the longest ever recorded. This is 222% longer than the 9.3 week wait in 1993. During this time numerous efforts were made to address the wait times issue but the results demonstrate that no improvement has occurred. It is worse.
The 30-week total is comprised of the time from referral by a family doctor (if you are fortunate enough to have one) to consultation with a specialist (15 weeks) and from consultation with a specialist to treatment (15 weeks). This is the median time which means the wait could be considerably longer for some people.
The Province of Ontario just reported the shortest total wait times (23.6 weeks). However, clarity around this figure is required as to whether this is a result of the millions of patients without a family doctor and those patients being unable to access specialty care through primary care referrals. If this is the case, there is an unmeasured pent-up demand in the community that may appear as Ontario attempts to expand its primary care access over the next several years. Time will tell but Ontario should expect its wait times to grow.
The Fraser Institute report also indicates that Canadians are currently waiting for a total of 1,543,994 medical procedures. In coming years with an aging and growing population we can expect this number to grow, especially with the impact of Long COVID.
There is no doubt the road ahead in healthcare will be challenging. The volume of services needed and the array of treatments that are in the health care pipeline require decision-makers to think differently than they have in the past. What needs to be urgently accepted by our politicians is that the threat of our collapsing health care system is real. It cannot be denied. It will take a toll on the health and productivity of Canadians and an economic toll on this country.
Acknowledging Canada’s health care system failings is a necessary step for Canada’s politicians to work toward creating a truly universal health care system. In all seriousness, the waiting game is over for Canada’s health “wait-for-care” system.
View related short video:
Why politicians cannot deliver on health care reform
Dr. Merrilee Fullerton’s book “A Physician in the Political Arena” can be read here.
References
“More than 74,000 Canadians have died on health-care wait lists since 2018: report”, National Post, January 15, 2025
https://nationalpost.com/news/canada/canadians-health-care-wait-list-deaths
“15,474 Canadians Died Waiting for Health Care in 2023-24”, SecondStreet.org, January 15, 2025
https://secondstreet.org/2025/01/15/15474-canadians-died-waiting-for-health-care-in-2023-24/
“Canadians waiting longer for priority surgeries and diagnostic imaging compared with pre-pandemic period”, CIHI, April 4, 2024
“Hundreds line up for chance at family doctor”, CTV News, January 16, 2025
https://www.ctvnews.ca/london/article/hundreds-line-up-for-chance-at-family-doctor/
“Troubling Diagnosis: Comparing Canada’s Healthcare with International Peers”, C.D. Howe Institute, January 14, 2025
“Waiting Your Turn”, Fraser Institute, December 12, 2024
https://www.fraserinstitute.org/studies/waiting-your-turn-wait-times-for-health-care-in-canada-2024
“Statement from the Minister of Health on the Canada Health Act”, Government of Canada, January 10, 2025