As we enter the year 2022, most Canadians will have lived their entire lives under the shibboleth that says we have the best healthcare system in the world. Our beloved medicare is universal in scope, free of charge and offers equal access to all. What country could beat that?
As it turns out, most countries can – hands down.
Year after year, we see the results of studies that objectively demonstrate that Canada’s healthcare system is inferior to similar systems in almost every way. Yet, the illusion continues unabated in our patriotic hearts.
In the most recent comparative study to evaluate the universal healthcare systems of 28 high-income countries, the only category that placed Canada anywhere near the top of the list was the amount spent on healthcare. We ranked second out of 28 countries (when spending is compared as a share of gross domestic product).
Despite all the money flowing into the system ($308 billion in 2021), critical metrics show that Canadian healthcare is on life support. We ranked 26th of 28 countries in numbers of doctors, 25th out of 26 for numbers of hospital beds and 24th of 28 for numbers of psychiatric beds. These dismal rankings continued when comparing inventories of medical technology like MRI and CT scanners.
Canada finished dead last when compared to the 10 countries that measure wait times, which holds true whether the measure is waiting for a specialist or surgery. The numbers explain why 1.2 million Canadians were left without medical care in 2020. The unduly long waits are not simply a function of COVID-19 as our wait lists have passed the one-million mark every year since 2017. In fact, due to our languid conversion to e-records, the full consequences of COVID-19 have yet to be determined.
All of this translates into an embarrassment on the international front and dire consequences for those on the home front. No wonder the following descriptors were used in a discussion of key conclusions: below average, too expensive, provides little value for money spent.
Our access to care is obviously compromised, but the most disturbing finding is that there are no surprises here. Comparative studies have yielded remarkably similar results for years, yet we continue to show little interest in making essential changes to improve healthcare.
The impetus for transition, improvement and modernization simply isn’t there.
Where’s the outrage?
One reason for our collective inaction is our failure to understand the fundamental principle that underlies our healthcare system: universal care is rationed care.
Universal care is based on an intangible principle that claims that healthcare is comprehensive and can be all things to all people. But just saying so doesn’t make it so and, in the realities of day-to-day medical care, universal care quickly becomes rationed care.
There’s only enough money to fund a certain number of doctors, surgeries, hospitals and diagnostic procedures. Sadly, the only logical endpoint for the rationed-care game is denying care to patients and forcing them to wait for what their doctors have deemed to be medically-necessary treatment.
In short, that means our healthcare system, as is, will never get better. There will always be people waiting.
Some people can wait without concerns. Others may lose their ability to work and earn a living; suffer a decline in their overall health and quality of life (particularly true in older people); experience exacerbated pain levels, and require more potent, addictive painkillers. Long waits can also result in multiple visits to an emergency ward for transitory care and negatively impact a person’s mental and emotional health.
All of these side issues can result in much higher overall costs to our health and social systems than treating the problem as soon as possible, yet they’re rarely considered when putting a patient on a wait list.
None of this bodes well for a society with a rapidly aging population and suffering from chronic illnesses that require greater oversight, more visits to specialists and repeat access to various diagnostic procedures.
Susan Martinuk is a research associate with the Frontier Centre for Public Policy and author of the soon-to-be-released book, Patients at Risk: Exposing the Crisis in Canada’s Health-care System.
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