Fraser Institute
Australia’s universal health-care system outperforms Canada on key measures including wait times, costs less and includes large role for private hospitals

The Role of Private Hospitals in Australia’s Universal Health Care System
From the Fraser Institute
by Mackenzie Moir and Bacchus Barua
In the wake of the COVID-19 pandemic, provincial governments across Canada relied on private
clinics in order to deliver a limited number of publicly funded surgeries in a bid to clear unprecedented
surgical backlogs. Subsequently, surveys indicated that 78% of Canadians support allowing more
surgeries and tests performed in private clinics while 40% only support this policy to clear the
surgical backlog. While a majority of Canadians are either supportive (or at the very least curious)
about these arrangements, the use of private clinics continues to be controversial and raise questions
around their compatibility with the provision of universal care.
The reality is that private hospitals play a key role in delivering care to patients in other countries with universal health care. Canada is only one of 30 high-income countries with universal care and many of these countries involve the private-sector in their health-care systems to a wide extent while performing better than Canada.
Australia is one of these countries and routinely outperforms Canada on key indicators of health-care performance while spending at a similar or lower level. Like Canada, Australia ranked
in the top ten for health-care spending (as a percentage of GDP and per capita) in 2020. However, after adjusting for the age of the population, it outperforms Canada on 33 (of 36) measures of performance.
Importantly, Australia outperformed Canada on a number of key measures such as the availability of physicians, nurses, hospital beds, CT scanners, and MRI machines. Australia also outperformed
Canada on every indicator of timely access to care, including ease of access to after-hours care, same-day primary care appointments, and, crucially, timely access to elective surgical care and specialist appointments.
Australia’s universal system is also characterized by a deep integration between the public and private sectors in the financing and delivery of care. Universal health-insurance coverage is provided through its public system known as Medicare. However, Australia also has a large private health-care sector that also finances and delivers medical services. Around half of the Australian population (55.2% in 2021/22) benefit from private health-insurance coverage provided by 33 registered not-for-profit and for-profit private insurance companies.
Private hospitals (for profit and not for profit) made up nearly half (48.5%) of all Australian hospitals in 2016 and contain a third of all care beds. These hospitals are a major partner in the delivery of care in Australia. For example, in 2021/22 41% of all recorded episodes of hospital care occurred in private hospitals. While delivering a small minority of emergency care (8.2%), private hospitals delivered the majority of recorded elective care (58.6%) and 70.3% of elective admissions involving surgery.
Private hospitals primarily deliver care to fully funded public patients in two ways. The first is contracted
care, either through ad hoc inter-hospital contracts or formal programs. Fully publicly funded episodes of care occurring in private hospitals made up 6.4% of all care in private hospitals, while representing 2.6% of all recorded care. The second way is privately delivered care paid for through the Department of Veterans’ Affairs. A full 73.5% of care paid for by the Department of Veterans’ Affairs occurred in private hospitals.
It would be easy, however, to underestimate the significance of this public-private partnership by examining only the delivery of care that is fully publicly funded. Privately insured care is also partially subsidized by the government, at a rate of 75% of the public fee. Therefore, in order to understand the full extent of publicly funded or subsidized care in private hospitals, it is helpful to examine private hospital expenditures by the source of funds. In 2019/20, 32.8% of private hospital expenditures came from government sources, 18.2% of which came from private health-insurance rebates. This means that a full
third of private hospital expenditure comes from a range of public sources, including the federal government.
Overall, private hospitals are important partners in the delivery of care within the Australian universal healthcare system. The Australian system outranks Canada’s on a range of performance indicators, while spending less as a percentage of GDP. Further, the integration of private hospitals into the delivery of care, including public care, occurs while maintaining universal access for residents.
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Business
Latest shakedown attempt by Canada Post underscores need for privatization

From the Fraser Institute
By Alex Whalen and Jake Fuss
For the second time in just six months, the Canadian Union of Postal Workers (CUPW) is threatening strike action. As Canadians know all too well, postal strikes can be highly disruptive given the federal government provides Canada Post with a near-monopoly on letter mail across the country. CUPW is well aware of this and uses it to their advantage in negotiations. While CUPW has the right to ask for whatever they like, Canadians should finally be freed from this albatross.
In January, the Trudeau government loaned Canada Post a whopping $1.034 billion to help “maintain its solvency and continue operating.” Since 2018, Canada Post has lost more than $4.6 billion, and according to its latest financial update, lost more than $100 million in the first quarter of 2025 alone. Canadians are on the hook for these losses because the federal government owns Canada Post.
Salaries and other employee costs comprise more than 66 per cent of Canada Post’s expenses, and CUPW and Canada Post management both know they can simply pass any losses on to Canadians. Consequently, there’s less incentive for management to control the bottom line or make reasonable budget requests when negotiating with the government. But if the government privatizes Canada Post, it would impose a proper constraint on costs that doesn’t currently exist. This is only fair given there’s no compelling reason why Canadians should underwrite the inflation of salaries in a money-losing Crown corporation.
Of course, government ownership of Canada Post is archaic. When the organization was founded more than 250 years ago, the world was quite different. In today’s age of Amazon, a plethora of delivery services exist coast-to-coast that serve Canadian consumers. Other countries including the Netherlands, Austria and Germany long ago privatized their postal services. The result was increased competition, which in turn reduced prices and improved quality.
Alongside privatization, the federal government should also eliminate Canada Post’s near-monopoly status on letter mail. This policy is purportedly meant to ensure universal service. But in reality, it prohibits other potential service providers from entering the letter-delivery market (including in remote areas that may experience less Canada Post service post-privatization), deprives Canadians of choice, and crucially, reduces the incentive for Canada Post to improve its service.
Simply put, the federal government should focus on its core responsibilities, and delivering mail is clearly not one of them. Given Canada Post’s latest attempted shakedown of Canadians, it’s never been clearer that it’s time for Canada Post to go the way of Air Canada, de Havilland and CN Rail. Once upon a time, the federal government owned all three of these entities until it became clear there was no reason for the government to own an airline, build planes or deliver goods by train. Why is letter mail any different? Canadians deserve better.
Business
Municipal government per-person spending in Canada hit near record levels

From the Fraser Institute
Municipal government spending in Canada hit near record levels in recent years, finds a new study by the Fraser Institute, an independent, non-partisan Canadian public policy think-tank.
“In light of record-high spending in municipalities across Canada, residents should consider whether or not crime, homelessness, public transit and other services have actually improved,” said Austin Thompson, senior policy analyst at the Fraser Institute and author of The Expanding Finances of Local Governments in Canada.
From 2000 to 2023, per-person spending (inflation-adjusted) increased by 25.2 per cent, reaching a record-high $5,974 per person in 2021 before declining slightly to $5,851 in 2023, the latest year of available data.
During that same period, municipal government revenue—generated from property taxes and transfers from other levels of government—increased by 33.7 per cent per person (inflation-adjusted).
And yet, among all three levels of government including federal and provincial, municipal government spending (adjusted for inflation) has actually experienced the slowest rate of growth over the last 10 years, underscoring the large spikes in spending at all government levels across Canada.
“Despite claims from municipal policymakers about their dire financial positions, Canadians should understand the true state of finances at city hall so they can decide whether they’re getting good value for their money,” said Jake Fuss, director of fiscal studies at the Fraser Institute.
The Expanding Finances of Local Governments in Canada, 1990–2023
- Canada’s local governments have experienced substantial fiscal growth in recent decades.
- Revenue and expenditure by local governments—including municipal governments, school boards, and Indigenous governments—have increased faster than population growth and inflation combined. From 1990 to 2023, real per-capita revenue rose by 32.7%, and expenditure by 30.0%.
- Local governments represent a significant component of Canada’s broader public sector. In 2023, net of inter-governmental transfers, municipal governments and school boards accounted for 18.6% of total government expenditure and 11.1% of revenue.
- Despite this growth, local governments’ share of overall government revenue and expenditure has declined over time—especially since the COVID-19 pandemic—as federal and provincial budgets have expanded even more rapidly.
- Nevertheless, between 2008 and 2023 the inflation-adjusted per-capita revenue of municipal governments in-creased by 10.1% and their expenditure by 12.4% , on average across the provinces.
- Over the same period, municipal governments recorded above-inflation increases in their combined annual operating surpluses, which contributed to an 88.1% inflation-adjusted rise in their net worth—raising important questions about the allocation of accumulated resources.
- In 2023, Ontario recorded the highest per-capita municipal revenue among the provinces ($4,156), while Alberta had the highest per-capita expenditure ($3,750). Prince Edward Island reported the lowest per-capita municipal revenue ($1,635) and expenditure ($1,186).
- Wide variation in per-capita municipal revenue and expenditure across the provinces reflects differences in the responsibilities provinces assign to municipalities, as well as possible disparities in the efficiency of service delivery—issues that warrant further scrutiny.
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