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:
Economy
Affordable housing out of reach everywhere in Canada
From the Fraser Institute
By Steven Globerman, Joel Emes and Austin Thompson
According to our new study, in 2023 (the latest year of comparable data), typical homes on the market were unaffordable for families earning the local median income in every major Canadian city
The dream of homeownership is alive, but not well. Nearly nine in ten young Canadians (aged 18-29) aspire to own a home—but share a similar worry about the current state of housing in Canada.
Of course, those worries are justified. According to our new study, in 2023 (the latest year of comparable data), typical homes on the market were unaffordable for families earning the local median income in every major Canadian city. It’s not just Vancouver and Toronto—housing affordability has eroded nationwide.
Aspiring homeowners face two distinct challenges—saving enough for a downpayment and keeping up with mortgage payments. Both have become harder in recent years.
For example, in 2014, across 36 of Canada’s largest cities, a 20 per cent downpayment for a typical home—detached house, townhouse, condo—cost the equivalent of 14.1 months (on average) of after-tax income for families earning the median income. By 2023, that figure had grown to 22.0 months—a 56 per cent increase. During the same period for those same families, a mortgage payment for a typical home increased (as a share of after-tax incomes) from 29.9 per cent to 56.6 per cent.
No major city has been spared. Between 2014 and 2023, the price of a typical home rose faster than the growth of median after-tax family income in 32 out of 36 of Canada’s largest cities. And in all 36 cities, the monthly mortgage payment on a typical home grew (again, as a share of median after-tax family income), reflecting rising house prices and higher mortgage rates.
While the housing affordability crisis is national in scope, the challenge differs between cities.
In 2023, a median-income-earning family in Fredericton, the most affordable large city for homeownership in Canada, had save the equivalent of 10.6 months of after-tax income ($56,240) for a 20 per cent downpayment on a typical home—and the monthly mortgage payment ($1,445) required 27.2 per cent of that family’s after-tax income. Meanwhile, a median-income-earning family in Vancouver, Canada’s least affordable city, had to spend the equivalent of 43.7 months of after-tax income ($235,520) for a 20 per cent downpayment on a typical home with a monthly mortgage ($6,052) that required 112.3 per cent of its after-tax income—a financial impossibility unless the family could rely on support from family or friends.
The financial barriers to homeownership are clearly greater in Vancouver. But, crucially, neither city is truly “affordable.” In Fredericton and Vancouver, as in every other major Canadian city, buying a typical home with the median income produces a debt burden beyond what’s advisable. Recent house price declines in cities such as Vancouver and Toronto have provided some relief, but homeownership remains far beyond the reach of many families—and a sharp slowdown in homebuilding threatens to limit further gains in affordability.
For families priced out of homeownership, renting doesn’t offer much relief, as rent affordability has also declined in nearly every city. In 2014, rental rates for the median-priced rental unit required 19.8 per cent of median after-tax family income, on average across major cities. By 2023, that figure had risen to 23.5 per cent. And in the least affordable cities for renters, Toronto and Vancouver, a median-priced rental required more than 30 per cent of median after-tax family income. That’s a heavy burden for Canada’s renters who typically earn less than homeowners. It’s also an added financial barrier to homeownership— many Canadian families rent for years before buying their first home, and higher rents make it harder to save for a downpayment.
In light of these realities, Canadians should ask—why have house prices and rental rates outpaced income growth?
Poor public policy has played a key role. Local regulations, lengthy municipal approval processes, and costly taxes and fees all combine to hinder housing development. And the federal government allowed a historic surge in immigration that greatly outpaced new home construction. It’s simple supply and demand—when more people chase a limited (and restricted) supply of homes, prices rise. Meanwhile, after-tax incomes aren’t keeping pace, as government policies that discourage investment and economic growth also discourage wage growth.
Canadians still want to own homes, but a decade of deteriorating affordability has made that a distant prospect for many families. Reversing the trend will require accelerated homebuilding, better-paced immigration and policies that grow wages while limiting tax bills for Canadians—changes governments routinely promise but rarely deliver.
Agriculture
Canada’s air quality among the best in the world
From the Fraser Institute
By Annika Segelhorst and Elmira Aliakbari
Canadians care about the environment and breathing clean air. In 2023, the share of Canadians concerned about the state of outdoor air quality was 7 in 10, according to survey results from Abacus Data. Yet Canada outperforms most comparable high-income countries on air quality, suggesting a gap between public perception and empirical reality. Overall, Canada ranks 8th for air quality among 31 high-income countries, according to our recent study published by the Fraser Institute.
A key determinant of air quality is the presence of tiny solid particles and liquid droplets floating in the air, known as particulates. The smallest of these particles, known as fine particulate matter, are especially hazardous, as they can penetrate deep into a person’s lungs, enter the blood stream and harm our health.
Exposure to fine particulate matter stems from both natural and human sources. Natural events such as wildfires, dust storms and volcanic eruptions can release particles into the air that can travel thousands of kilometres. Other sources of particulate pollution originate from human activities such as the combustion of fossil fuels in automobiles and during industrial processes.
The World Health Organization (WHO) and the Canadian Council of Ministers of the Environment (CCME) publish air quality guidelines related to health, which we used to measure and rank 31 high-income countries on air quality.
Using data from 2022 (the latest year of consistently available data), our study assessed air quality based on three measures related to particulate pollution: (1) average exposure, (2) share of the population at risk, and (3) estimated health impacts.
The first measure, average exposure, reflects the average level of outdoor particle pollution people are exposed to over a year. Among 31 high-income countries, Canadians had the 5th-lowest average exposure to particulate pollution.
Next, the study considered the proportion of each country’s population that experienced an annual average level of fine particle pollution greater than the WHO’s air quality guideline. Only 2 per cent of Canadians were exposed to fine particle pollution levels exceeding the WHO guideline for annual exposure, ranking 9th of 31 countries. In other words, 98 per cent of Canadians were not exposed to fine particulate pollution levels exceeding health guidelines.
Finally, the study reviewed estimates of illness and mortality associated with fine particle pollution in each country. Canada had the fifth-lowest estimated death and illness burden due to fine particle pollution.
Taken together, the results show that Canada stands out as a global leader on clean air, ranking 8th overall for air quality among high-income countries.
Canada’s record underscores both the progress made in achieving cleaner air and the quality of life our clean air supports.
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