COVID or not—Canada’s health-care system faces major challenges

Nineteen months into the COVID pandemic, Canada’s health-care system continues to face serious challenges, with hospitals in some provinces struggling with overcrowded ICU’s and staff burnout. The result? Despite progress in some quarters, elective surgeries are once again being postponed and non-COVID patients will have to wait for medically necessary care.

While it may be tempting to blame our current challenges on COVID-19, our new study suggests the pandemic is exacerbating—but not causing—the systemic problems that plague our underperforming health-care system.

The study compares the spending and performance of 28 countries with universal health care (on an age-adjusted basis) using 2019 data (the most recent year of comparable available data from the OECD). In line with previous findings, we find that while Canada ranked as the second-highest spender (at 11.3 per cent of GDP) among its comparators, its performance on several key metrics was mediocre to poor.

For example, medical resources—on a per-person basis in 2019, Canada ranked 25th out of 26 countries for acute care beds (2.0 beds per 1,000 population). By contrast, the highest-ranking country, South Korea, had 8.0 beds per 1,000 population.

Unfortunately, beds aren’t the only major resource Canada lacks, relative to other countries. The availability of medical personnel tells a similar story. In 2019, we had 2.8 physicians per 1,000 population, ranking 26th out of 28 countries. This was a far cry from countries such as Austria (5.3) and Norway (5.2). And crucially, Canada also ranked near the bottom for the relative availability of MRI machines (21st out of 24) and CT scanners (22nd out of 26).

When we consider these facts together, Canada’s long wait times for health care become less of a mystery. Indeed, the Commonwealth Fund’s latest international survey of the general population reveals that in 2020, Canada ranked dead last (10th out of 10) for wait times to see a specialist and receive elective surgery. Additionally, far more Dutch (69 per cent) and Swiss (68 per cent) participants reported waiting less than four weeks to see a specialist than Canadians (38 per cent). And for elective surgery, 99 per cent of Germans and 90 per cent of French citizens reported waiting less than four months versus 62 per cent of Canadians.

While the pandemic has obviously affected some of these wait times, older data tell the same story. Our health-care system struggled long before the pandemic—again, despite consistently being a top spender.

But the news this year isn’t all bad. Canada performed better than the average universal health-care country on survival rates for heart attacks (ranking 9th out of 27), breast cancer (5th out of 26) and rectal cancer (6th out of 26) despite the relative shortage of resources and long wait times. Indeed, these serve more as a testament to our health-care workers than to our resource-deficient system.

The past 19 months have pushed provincial health-care systems, and those who work in them, to their limits. Unfortunately, the “new normal” of endless hospital stress testing, scarce resources, surgical postponements and lengthening wait times is not much different from the “old normal” before the pandemic. Other countries have built health-care systems that demonstrably perform better at a comparable or lower cost. We should learn from them, enact new polices, reform the elements of our universal system where reform is most needed, and forge a “better normal” in the post-pandemic world.