British Columbians in the Lower Mainland heard last week there may not be as many operating rooms and hospital beds available as usual because the health authority planned some closures due to a budgetary shortfall. While the plans were ultimately shelved and replaced with other cost cutting measures, it is important for all British Columbians to ask the question: is money really the issue here? Are folks who suggest there is not enough money for health care in BC correct? Or is there something else going on?

First, some national numbers for perspective. Canada, on an age adjusted basis, operates the second most expensive universal access health care system among the world’s most developed nations. Only Iceland spends more on their universal access health care program than we do.

In exchange for that high level of spending, Canada’s government-run health care system provides relatively poor levels of access to physicians and technology and requires patients to endure some of the longest waiting lists in the developed world. Put another way, Canadian taxpayers are paying for a world-class health care system while getting access that ranges from mediocre to terrible.

Amongst the Canadian provinces, British Columbia is an above average spender but a below average performer. According to the Canadian Institute for Health Information, on a demographic adjusted basis BC’s government ranked fifth in health expenditures for the year 2004 (the latest available), just above the Canadian average. But for all that spending, British Columbia ranked fourth among the provinces in the number of physicians per capita, below the national average in the number of medical technologies like MRI and CT, and suffered a total median wait time for elective medical procedures that was longer than the national average. A below-par performance in a country that, as a whole, performs poorly yet spends a great deal suggests that there are serious problems with the health care program other than the money spent on it.

The real problem stems from the design of the system itself: British Columbia’s health care system is a massive, centrally controlled, government bureaucracy. And like most government bureaucracies, health care consumes increased funding with almost no change in the functioning of the system or the outcomes from it. The fact that patients are stuck waiting months or even years for care in BC will not change if more funding is made available to the health care system. NDP leader Carole James’ suggestion to spend more money out of the provincial surplus is not the solution.

The solution can, however, be found abroad, in countries like Austria, Belgium, France, Germany, Japan, Luxembourg, and Switzerland, where universal access health care systems are functioning for less money than ours and providing access to health care services for the population without waiting lists without regard for their ability to pay. Each of these countries embraces the “compassionate approach” to health services by promising all citizens access to care regardless of ability to pay, yet none has followed Canada’s model of health care delivery.

Each of these countries offers choice in the delivery of health care services by allowing the purchase and provision of competitive private health care and/or insurance. Each of these countries has a cost-sharing system in place because research and experience shows that patients are encouraged to make a more informed decision about how they use health services when care is not free at the point of use.

Finally, each of these countries allows private hospitals (both not-for-profit and for-profit) to competitively deliver publicly guaranteed health care services. That vibrant competition is what motivates health care providers to respond to patients’ needs and to deliver high quality, cost-effective services.

For patients in BC, adopting the policies found in these other developed countries would mean access to a better, more patient-oriented universal access health care system, where all patients receive the care they desire and do not have to wait for the care the government is willing to provide them. Comparative access to technology would improve as private investment brought more machines into the province, and waiting times would fall or even disappear as more care was provided for the same amount of money already being paid for health care.

Such changes would also mean that taxpayers would finally see value for the money that they have been paying into health care for years.

British Columbia’s health care system has the potential—and more than adequate resources—to serve patients and meet the demand for health care. However, the realization of that potential will require change. Until that change comes, patients will continue to languish on the province’s waiting lists and their care will continue to be pushed off to maintain budgetary limits.