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Paramedics transfer patients to the emergency room triage but have no choice but to leave them in the hallway due to an at-capacity emergency room at the Humber River Hospital during the COVID-19 pandemic in Toronto on Jan. 25, 2022.The Canadian Press

Nigel Rawson is a senior fellow with the Macdonald-Laurier Institute. John Adams is co-founder and CEO of Canadian PKU and Allied Disorders Inc., a senior fellow with the Macdonald-Laurier Institute and volunteer board chair of Best Medicines Coalition.

Canadians know all too well that their health care delivery system is in crisis.

There aren’t enough doctors, nurses, or hospital beds. Paramedics are forced to wait for hours to drop off patients because of overcrowding. Some hospitals – their hallways lined with patients on gurneys – are even being cited for breaking fire regulations. Appalling surgery wait times continue to grow longer, and some patients are literally dying from lack of attention. It’s clear that the system has reached a breaking point. The COVID-19 pandemic brought already existing problems starkly into focus and exacerbated them.

A great part of the problem is in how inefficiently our health care funding is spent. OECD data and other sources show that, up against 30 comparable countries, Canada ranks among the top 10 in health care spending per person. However, we rank close to the bottom on numbers of physicians, nurses, acute care, long-term care and psychiatric beds, MRIs and CT and PET scanners per capita. In addition, Canadians wait longer for new innovative medicines than Americans and Europeans, and even longer for public funding for those medicines once they are launched here.

The inefficient use of funding is compounded by the lack of investment in health research and development. Canada is the only G7 country whose R&D expenditure as a proportion of gross domestic product shrank between 2000 and 2020, resulting in Canada being ranked 18th among OECD countries in 2020.

The U.S. National Institutes of Health has an annual R&D budget of more than US$45-billion – more than US$132 per capita. In comparison, the Canadian Institutes of Health Research invests about $1-billion per year to support health research, which is about $25 (US$18.50) per capita – that’s less than one-seventh of U.S. spending. In addition, the per capita rate of private investment in drug discovery, development and commercialization in the United States far exceeds Canada’s.

The federal government appointed an advisory panel in 2016 to identify gaps in R&D support and make recommendations to improve Canada’s performance, but then largely ignored its suggestions. This has been the fate of other similar reviews and is likely to be the same for yet another panel’s report, published in 2023.

Canadian governments want industry and academic institutions to undertake health research without providing them sufficient resources. One result is that Canada is “a country of perpetual pilot projects” in health research – seldom are projects proved to be effective and put widely into practice.

Underinvestment results in fewer discoveries in our academic institutions, fewer clinical trials (this means Canadians have fewer opportunities to access promising novel medicines for life-threatening diseases such as cancer and ALS) and fewer new medicines being launched in Canada. These lost opportunities also mean there are fewer good-paying jobs in R&D, which hurts our economy.

As in overall defence spending – the sorry state of equipment, supplies and trained personnel in our armed forces, and our paltry contributions to NORAD and NATO – Canada has been freeloading on the back of U.S. public and private investments in health for years. Canadians should thank Americans for their tremendous efforts in improving health care by developing biopharmaceuticals and other treatments. Without their R&D investment, Canadians would be much less healthy.

Canada must step up to play its part in the relationship with the U.S. health sector. As the first Trump presidency showed, an isolationist administration can make things extremely uncomfortable. Our neighbours to the south will only accept a laggard partner for so long.

The only truly universal feature of Canada’s health care system is that everyone gets to wait. Canada needs a new approach to investing in health security – our lives and future depend on it.

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