Health
Public coverage of cross-border health care would help reduce waiting times
News release from the Montreal Economic Institute and Second Street
450,000 European patients had surgery outside their country of residence in 2022
Allowing Canadian patients to get reimbursed from the government for care received outside the country – just like Europeans do – would help reduce waiting times, according to an economic note published jointly by the Montreal Economic Institute and SecondStreet.org this morning.
“Long waiting times for surgery in Canada have damaging effects on patients‘ health and quality of life,” says Frederik Cyrus Roeder, health economist and author of the study. “Allowing Canadian patients to seek treatment elsewhere would help them regain their health, while breaking the cycle of constant catching up in Canadian healthcare systems.”
Since 2011, European patients have been permitted to seek treatment in any EU member country and receive reimbursement of their medical expenses equivalent to what their national health insurance plan would have covered at home.
This mechanism is known as the “cross-border directive,” or the “patients’ rights directive.”
Thanks to this arrangement, 450,000 European patients were able to access elective surgery outside their country of residence in 2022. Nearly 80% of the requests submitted that year were approved.
The economist explains that a large part of the voluntary program’s success is due to the fact that it acts as a safety valve when healthcare systems are no longer delivering.
“Such a system is no more expensive for the public insurer, because the reimbursements provided cannot exceed the costs of delivering the same treatment in the local healthcare system,” explains Mr. Roeder. “Where this directive really comes into its own is when a healthcare system can no longer manage to treat patients within an acceptable timeframe.”
“Patients are then free to turn to other alternatives without having to pay a stiff price. It’s important to note that even patients who don’t want to travel for treatment still benefit from this as it helps shorten waiting lists.”
In 2023, more than four out of ten Canadian patients had to wait longer than the recommended time to obtain a knee replacement in Canada. For hip replacements, the figure was one in three.
The joint study by the MEI and SecondStreet.org is available here.
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The MEI is an independent public policy think tank with offices in Montreal and Calgary. Through its publications, media appearances, and advisory services to policymakers, the MEI stimulates public policy debate and reforms based on sound economics and entrepreneurship.
SecondStreet.org launched in 2019 to focus on researching how government policies affect everyday Canadians. In addition to policy research, we tell short stories featuring Canadians from coast-to-coast explaining how they’re affected by government policies.
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
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