Fraser Institute
Other countries with universal health care don’t have Canada’s long wait times
From the Fraser Institute
By Mackenzie Moir and Bacchus Barua
Unfortunately it’s now very common to see stories about how long provincial wait times for medical care are driving patients to seek care elsewhere, often at great personal cost. Take the recent case of the Milburns in Manitoba who, after waiting years for a knee surgery, are now considering selling their home and moving to Alberta just to get on a potentially shorter public wait list.
Patients in Manitoba could expect to wait a median of 29 weeks to see an orthopedic specialist after a referral from a family physician, then they still faced a median 24.4 week wait to get treatment. In other words, the total typical wait for orthopedic surgery in the province is more than one year at 53.4 weeks. Remember, that’s a median measure, which means some patients wait much longer.
Unfortunately, the Milburns are unlikely to get more timely care on the public wait list in Alberta. At 64.1 weeks, the total median wait for orthopedic care in Alberta was actually longer than in Manitoba. And this doesn’t include the time it takes for provincial coverage to activate for a new provincial resident, or the time it will take to find a new family doctor and get the necessary tests, scans and referrals.
To get more timely care, the Milburns are left with unenviable options. Because they’re insured by Manitoba’s public health-care plan, paying for covered care out of pocket is restricted. They can, however, pay for and receive care privately in other provinces as uninsured visitors (i.e. not move there permanently). Specifically, certain provinces have “exemptions” that allow physicians to charge out-of-province patients directly to provide these procedures privately.
Alternatively, the Milburns could leave Canada and travel even further from home to receive timely care abroad.
But it doesn’t have to be this way.
Long wait times are not the necessary price Canadians must pay for universal coverage. In fact, Canada is one of 30 high-income countries with universal health care. Other countries such as Switzerland, the Netherlands, Germany and Australia have much shorter wait times. For example, only 62 per cent of Canadians reported access to non-emergency surgery in less than four months in 2020 compared to 99 per cent of Germans, 94 per cent of Swiss and 72 per cent of Australians.
The difference? These countries approach health care in a fundamentally different way than us. One notable difference is their attitude towards the private sector.
In Germany, patients can seek private care while still insured by the public system or can opt out and purchase regulated private coverage. These approaches (universal, privately paid or privately insured) are able to deliver rapid access to care. The Swiss simply mandate that patients purchase private insurance in a regulated-but-competitive marketplace as part of their universal scheme. Lower-income families receive a subsidy so they can participate on a more equal footing in the competitive marketplace to obtain the insurance that best fits their needs.
Perhaps the most direct comparator to Canada is Australia—not just geographically, but because it also primarily relies on a tax-funded universal health-care system. However, unlike Canada, individuals can purchase private insurance to cover (among other things) care received as a private patient in a public or private hospital, or simply pay for their private care directly if they choose. In 2021/22 more than two-thirds (70 per cent) of non-emergency admissions to a hospital involving surgery (both publicly and privately funded) took place in a private facility.
Of course, these faster-access countries share other differences in attitudes to universal health-care policy including requirements to share the cost of care for patients and funding hospitals on the basis of activity (instead of Canada’s outdated bureaucratically-determined budgets). A crucial difference, however, is that patients are not generally prevented from paying privately for health care in their home province (or canton or state) in any of these countries.
Without fundamental reform, and as provincial systems continue to struggle to provide basic non-emergency care, we’ll continue to see more stories like the Milburn’s. Without reform, many Canadians will continue to be forced to make similarly absurd decisions to get the care they need, rather than focusing on treatment and recovery.
Authors:
From the Fraser Institute
Canadians continue to endure long wait times for health care. And while waiting for care can obviously be detrimental to your health and wellbeing, it can also hurt your pocketbook.
In 2024, the latest year of available data, the median wait—from referral by a family doctor to treatment by a specialist—was 30 weeks (including 15 weeks waiting for treatment after seeing a specialist). And last year, an estimated 1.5 million Canadians were waiting for care.
It’s no wonder Canadians are frustrated with the current state of health care.
Again, long waits for care adversely impact patients in many different ways including physical pain, psychological distress and worsened treatment outcomes as lengthy waits can make the treatment of some problems more difficult. There’s also a less-talked about consequence—the impact of health-care waits on the ability of patients to participate in day-to-day life, work and earn a living.
According to a recent study published by the Fraser Institute, wait times for non-emergency surgery cost Canadian patients $5.2 billion in lost wages in 2024. That’s about $3,300 for each of the 1.5 million patients waiting for care. Crucially, this estimate only considers time at work. After also accounting for free time outside of work, the cost increases to $15.9 billion or more than $10,200 per person.
Of course, some advocates of the health-care status quo argue that long waits for care remain a necessary trade-off to ensure all Canadians receive universal health-care coverage. But the experience of many high-income countries with universal health care shows the opposite.
Despite Canada ranking among the highest spenders (4th of 31 countries) on health care (as a percentage of its economy) among other developed countries with universal health care, we consistently rank among the bottom for the number of doctors, hospital beds, MRIs and CT scanners. Canada also has one of the worst records on access to timely health care.
So what do these other countries do differently than Canada? In short, they embrace the private sector as a partner in providing universal care.
Australia, for instance, spends less on health care (again, as a percentage of its economy) than Canada, yet the percentage of patients in Australia (33.1 per cent) who report waiting more than two months for non-emergency surgery was much higher in Canada (58.3 per cent). Unlike in Canada, Australian patients can choose to receive non-emergency surgery in either a private or public hospital. In 2021/22, 58.6 per cent of non-emergency surgeries in Australia were performed in private hospitals.
But we don’t need to look abroad for evidence that the private sector can help reduce wait times by delivering publicly-funded care. From 2010 to 2014, the Saskatchewan government, among other policies, contracted out publicly-funded surgeries to private clinics and lowered the province’s median wait time from one of the longest in the country (26.5 weeks in 2010) to one of the shortest (14.2 weeks in 2014). The initiative also reduced the average cost of procedures by 26 per cent.
Canadians are waiting longer than ever for health care, and the economic costs of these waits have never been higher. Until policymakers have the courage to enact genuine reform, based in part on more successful universal health-care systems, this status quo will continue to cost Canadian patients.
Mackenzie Moir
Senior Policy Analyst, Fraser Institute
Business
84% of Swiss hospitals and 60% of hospitalizations are in private facilities, and they face much lower wait times
From the Fraser Institute
If Canada reformed to emulate Switzerland’s approach to universal health care, including its much greater use of private sector involvement, the country would deliver far better results to patients and reduce wait times, finds a new study published today by the Fraser Institute, an independent, non-partisan Canadian policy think-tank.
“The bane of Canadian health care is lack of access to timely care, so it’s critical to look to countries like Switzerland with more successful universal health care,” said Yanick Labrie, senior fellow at the Fraser Institute and author of Integrating Private Health Care Into Canada’s Public System: What We Can Learn from Switzerland. The study highlights how Switzerland successfully integrates the private sector into their universal health-care system, which consistently outperforms Canada on most health-care metrics, including wait times.
For example, in 2022, the percentage of patients who waited less than two months for a specialist appointment was 85.3 per cent in Switzerland compared to just 48.3 per cent in Canada.
In Switzerland, 84.2 per cent of all hospitals are private (either for-profit or not-for profit) institutions, and the country’s private hospitals provide 60.2 per cent of all hospitalizations, 60.9 per cent of all births, and 67.1 per cent of all operating rooms.
Crucially, Swiss patients can obtain treatment at the hospital of their choice, whether located inside or outside their geographic location, and hospitals cannot discriminate against patients, based on the care required.
“Switzerland shows that a universal health-care system can reconcile efficiency and equity–all while being more accessible and responsive to patients’ needs and preferences,” Labrie said.
“Based on the success of the Swiss model, provinces can make these reforms now and help improve Canadian health care.”
Integrating Private Health Care into Canada’s Public System: What We Can Learn from Switzerland
- Access to timely care remains the Achilles’ heel of Canada’s health systems. To reduce wait times, some provinces have partnered with private clinics for publicly funded surgeries—a strategy that has proven effective, but continues to spark debate in Canada.
- This study explores how Switzerland successfully integrates private health care into a universal public system and considers what Canada can learn from this model.
- In Switzerland, universal coverage is delivered through a system of managed competition among 44 non-profit private insurers, while decentralized governance allows each of the 26 cantons to coordinate and oversee hospital services in ways that reflect local needs and priorities.
- Nearly two-thirds of Swiss hospitals are for-profit institutions; they provide roughly half of all hospitalizations, births, and hospital beds across the country.
- All hospitals are treated equally—regardless of legal status—and funded through the same activity-based model, implemented nationwide in 2012.
- The reform led to a significant increase in the number of cases treated without a corresponding rise in expenditures per case, suggesting improved efficiency, better use of resources, and expanded access to hospital care.
- The average length of hospital stay steadily decreased over time and now stands at 4.87 days in for-profit hospitals versus 5.53 days in public ones, indicating faster patient turnover and more streamlined care pathways.
- Hospital-acquired infection rates are significantly lower in private hospitals (2.7%) than in public hospitals (6.2%), a key indicator of care quality.
- Case-mix severity is as high or higher in private hospitals, countering the notion that they only take on simpler or less risky cases.
- Patient satisfaction is slightly higher in private hospitals (4.28/5) than in public ones (4.17/5), reflecting strong user experience across multiple dimensions.
- Canada could benefit from regulated competition between public and private providers and activity-based funding, without breaching the Canada Health Act.
Yanick Labrie
Senior Fellow, Fraser Institute
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