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Canadians are ready for health-care reform—Australia shows the way

Published

12 months ago

5 minute read

From the Fraser Institute

By Bacchus Barua and Mackenzie Moir

Australia offers real-world examples of how public/private partnerships can be successfully integrated in a universal health-care framework. Not only does Australia prove it can be done without sacrificing universal coverage for all, Australia spends less money (as a share of its economy) than Canada and enjoys more timely medical care.

Canada’s health-care system is crumbling. Long wait times, hallway health care and burned-out staff are now the norm. Unsurprisingly, a new poll finds that the majority of Canadians (73 per cent) say the system needs major reform.

As noted in a recent editorial in the Globe and Mail, we can learn key lessons from Australia.

There are significant similarities between the two countries with respect to culture, the economy and even geographic characteristics. Both countries also share the goal of ensuring universal health coverage. However, Australia outperforms Canada on several key health-care performance metrics.

After controlling for differences in age (where appropriate) between the two countries, our recent study found that Australia’s health-care system outperformed Canada’s on 33 (of 36) performance measures. For example, Australia had more physicians, hospital beds, CT scanners and MRI machines per person compared to Canada. And among the 30 universal health-care countries studied, Canada ranked in the bottom quartile for the availability of these critical health-care resources.

Australia also outperforms Canada on key measures of wait times. In 2023 (the latest year of available data), 39.5 per cent of patients in Australia were able to make a same or next day appointment when they were sick compared to only 22.3 per cent in Canada. And 9.6 per cent of Canadians reported waiting more than one year to see a specialist compared to only 4.5 per cent of Australians. Similarly, almost one-in-five (19.9 per cent) Canadians reported waiting more than one year for non-emergency surgery compared to only 11.8 per cent of Australians.

So, what does Australia do differently to outperform Canada on these key measures?

Although the Globe and Mail editorial touches on the availability of private insurance in Australia, less attention is given to the private sector’s prominent role in the delivery of health care.

In 2016 (the latest year of available data) almost half of all hospitals in Australia (48.5 per cent) were private. And in 2021/22 (again, the latest year of available data), 41 per cent of all hospital care took place in a private facility. That percentage goes up to 70.3 per cent when only considering hospital admissions for non-emergency surgery.

But it’s not only higher-income patients who can afford private insurance (or those paying out of pocket) who get these surgeries. The Australian government encourages the uptake of private insurance and partially subsidizes private care (at a rate of 75 per cent of the public fee), and governments in Australia also regularly contract out publicly-funded care to private facilities.

In 2021/22, more than 300,000 episodes of publicly-funded care occurred in private facilities in Australia. Private hospitals also delivered 73.5 per cent of care funded by Australia’s Department of Veterans’ Affairs. And in 2019/20, government sources (including the federal government) paid for almost one-third (32.8 per cent) of private hospital expenditures.

Which takes us back to the new opinion poll (by Navigator), which found that 69 per cent of Canadians agree that health-care services should include private-sector involvement. While defenders of the status quo continue to criticize this approach, Australia offers real-world examples of how public/private partnerships can be successfully integrated in a universal health-care framework. Not only does Australia prove it can be done without sacrificing universal coverage for all, Australia spends less money (as a share of its economy) than Canada and enjoys more timely medical care.

While provincial governments remain stubbornly committed to a failed model, Canadians are clearly expressing their desire for health-care reforms that include a prominent role for private partners in the delivery of universal care.

Australia is just one example. Public/private partnerships are the norm in several more successful universal health-care systems (such as Germany and Switzerland). Instead of continuing to remain an outlier, Canada should follow the examples of Australia and other countries and engage with the private sector to fulfill the promise of universal health care.

Authors:

Bacchus Barua and Mackenzie Moir
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Energy

National media energy attacks: Bureau chiefs or three major Canadian newspapers woefully misinformed about pipelines

Published on October 23, 2025

By

From the Fraser Institute

By Kenneth P. Green

These three allegedly well informed national opinion-shapers are incredibly ignorant of national energy realities.

In a recent episode of CPAC PrimeTime Politics, three bureau chiefs from three major Canadian newspapers discussed the fracas between Alberta Premier Danielle Smith and Prime Minister Mark Carney. The Smith government plans to submit a proposal to Ottawa to build an oil pipeline from Alberta to British Columbia’s north coast. The episode underscored the profound disconnect between these major journalistic gatekeepers and the realities of energy policy in Canada.

First out of the gate, the Globe and Mail’s Robert Fife made the (false) argument that we already have the Trans Mountain pipeline expansion (TMX), which is only running at 70 per cent, so we don’t need additional pipelines. This variant of the “no market case” argument misunderstands both the economics of running pipelines and the reality of how much oilsands production can increase to supply foreign markets if—and only if—there’s a way to get it there.

In reality, since the TMX expansion entered service, about 80 per cent of the system’s capacity is reserved for long-term contracts by committed shippers, and the rest is available on a monthly basis for spot shippers who pay higher rates due largely to government-imposed costs of construction. From June 2024 to June 2025, committed capacity was fully utilized each month, averaging 99 per cent utilization. Simply put, TMX is essentially fully subscribed and flowing at a high percentage of its physical capacity.

And the idea that we don’t need additional capacity is also silly. According to S&P Global, Canadian oilsands production will reach a record annual average production of 3.5 million barrels per day (b/d), and by 2030 could top 3.9 million b/d (that’s 500,000 b/d higher than 2024). Without pipeline expansion, this growth may not happen. Alberta’s government, which is already coordinating with pipeline companies such as Enbridge, hopes to see oilsands production double in coming years.

Next, Mia Rabson, Ottawa deputy bureau chief of the Canadian Press, implied that Smith’s proposal is not viable because it comes from government, not the private sector. But Rabson neglected to say that it would be foolish for any company to prepare a very expensive project proposal in light of current massive regulatory legislative barriers (tanker ban off B.C. coast, oil and gas emission cap, etc.). Indeed, proposal costs can run into the billions.

Finally, Joel-Denis Bellavance, Ottawa bureau chief of La Presse, opined that a year ago “building a pipeline was not part of the national conversation.” Really? On what planet? How thick is the bubble around Quebec? Is it like bulletproof Perspex? This is a person helping shape Quebec opinion on pipelines in Western Canada, and if we take him at his word, he doesn’t know that pipelines and energy infrastructure have been on the agenda for quite some time now.

If these are the gatekeepers of Canadian news in central Canada, it’s no wonder that the citizenry seems so woefully uninformed about the need to build new pipelines, to move Alberta oil and gas to foreign markets beyond the United States, to strengthen Canada’s economy and to employ in many provinces people who don’t work in the media.

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Business

Canada has fewer doctors, hospital beds, MRI machines—and longer wait times—than most other countries with universal health care

Published on October 21, 2025

By

From the Fraser Institute

By Mackenzie Moir

Despite a relatively high level of spending, Canada has significantly fewer doctors, hospital beds, MRI machines and CT scanners compared to other countries with universal health care, finds a new study released today by the Fraser Institute, an independent, non-partisan Canadian public policy think-tank.

“There’s a clear imbalance between the high cost of Canada’s health-care system and the actual care Canadians receive in return,” said Mackenzie Moir, senior policy
analyst at the Fraser Institute and author of Comparing Performance of Universal Health-Care Countries, 2025.

In 2023, the latest year of available comparable data, Canada spent more on health care (as a percentage of the economy/GDP, after adjusting for population age) than
most other high-income countries with universal health care (ranking 3rd out of 31 countries, which include the United Kingdom, Australia and the Netherlands).
And yet, Canada ranked 27th (of 30 countries) for the availability of doctors and 25th (of 30) for the availability of hospital beds.

In 2022, the latest year of diagnostic technology data, Canada ranked 27th (of 31 countries) for the availability of MRI machines and 28th (of 31) for CT scanners.
And in 2023, among the nine countries with universal health-care systems included in the Commonwealth Fund’s International Health Policy Survey, Canada ranked last for the percentage of patients able to make same- or next-day appointments when sick (22 per cent) and had the highest percentage of patients (58 per cent) who waited two months or more for non-emergency surgery. For comparison, the Netherlands had much higher rates of same- or next-day appointments (47 per cent) and much lower waits of two months or more for non-emergency surgery (20 per cent).

“To improve health care for Canadians, our policymakers should learn from other countries around the world with higher-performing universal health-care systems,”
said Nadeem Esmail, director of health policy at the Fraser Institute.

Comparing Performance of Universal Health Care Countries, 2025

  • Of the 31 high-income universal health-care countries, Canada ranks among the highest spenders, but ranks poorly on both the availability of most resources and access to services.
  • After adjustments for differences in the age of the population of these 31 countries, Canada ranked third highest for spending as a percentage of GDP in 2023 (the most recent year of comparable data).
  • Across 13 indictors measured, the availability of medical resources and timely access to medical services in Canada was generally below that of the average OECD country.
  • In 2023, Canada ranked 27th (of 30) for the relative availability of doctors and 25th (of 30) for hospital beds dedicated to physical care. In 2022, Canada ranked 27th (of 31) for the relative availability of Magnetic Resonance Im-aging (MRI) machines, and 28th (of 31) for CT scanners.
  • Canada ranked last (or close to last) on three of four indicators of timeliness of care.
  • Notably, among the nine countries for which comparable wait times measures are available, Canada ranked last for the percentage of patients reporting they were able to make a same- or next-day appointment when sick (22%).
  • Canada also ranked eighth worst for the percentage of patients who waited more than one month to see a specialist (65%), and reported the highest percentage of patients (58%) who waited two months or more for non-emergency surgery.
  • Clearly, there is an imbalance between what Canadians get in exchange for the money they spend on their health-care system.

Mackenzie Moir

Senior Policy Analyst, Fraser Institute
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