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By Jason Clemens
and Bacchus Barua
The Fraser Institute

As is often the case in U.S. politics, Canada’s healthcare system was raised during the recent Republican debate as a functioning alternative to the U.S. model.

But when front-runner Donald Trump described Canada’s healthcare system as working just fine, he was out of step with the facts.

Jason Clemens


Canada’s high-cost healthcare system delivers only modest performance across most measures of healthcare. Put simply, it is not something to be emulated but rather avoided.

In terms of cost, Canada’s system is among the most expensive among the OECD countries that provide universal access to healthcare, after adjusting for age. This latter point is important, since demographics are a key driver of healthcare costs. Data for 2011, the most recent year available, shows that Canada’s healthcare system was the second most expensive (measured as a share of the economy) among 27 OECD countries with universal access.

The cost of Canada’s healthcare system would be less worrying if it was deemed to be high-performing. On measure after measure, however, Canada’s performance is middling at best.

A central problem in Canada’s healthcare system and a driving force for reform are wait times for medical procedures. The latest data for waiting lists indicates that in 2014 Canadians could expect to wait 18.2 weeks for treatment after seeing a general practitioner, which is 96 percent longer than they had to wait in 1993.

Such wait times are three weeks longer than what physicians consider clinically reasonable.

Bacchus Barua

Bacchus Barua

In a comparative sense, Canada’s wait lists are among the worst in developed countries. According to the Commonwealth Fund, Canada ranked dead last on most measures of timeliness of care (behind 10 other countries, including the U.S.). Only 41 percent of Canadians were able to get an appointment the same day (or next) when sick, compared to 76 percent in Germany. Further, 29 percent of Canadians waited two months or more for a specialist appointment while only 3 percent reported such waits in Switzerland and the Netherlands.

There are also worrying statistics regarding Canadians’ access to medical doctors and technology. For instance, among OECD countries with universal access, Canada ranked close to the bottom of the pack for availability of practising doctors per thousand population (25 of 27), and below the OECD average for availability of MRI scanners per million population (16 of 24).

Health care reform is a central policy consideration for most industrialized countries both because of its cost to government and citizens and perhaps more importantly because it is a highly valued, personal service that citizens care deeply about. Successful reforms are premised on accurate information.

Contrary to Trump’s claims, Canada’s healthcare system is neither high-functioning nor provided at a reasonable cost. Rather than a model for reform, it is an example of what to avoid.

Jason Clemens is executive vice-president and Bacchus Barua is senior health economist at the Canadian-based Fraser Institute.

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