Mackenzie Moir, Alex Whalen and Bacchus Barua are analysts at the Fraser Institute.
The COVID-19 pandemic rages on, and there remains much we do not know about the novel coronavirus. But increasingly, the health implications beyond the virus itself are becoming clearer in British Columbia. In early May, the Horgan government estimated it will take up to two years to complete the 30,000 “non-urgent” surgeries that were cancelled during the pandemic, and to address the additional 24,000 patients waiting for surgery referrals. Thankfully, the B.C. government’s response plan includes private clinics, but broader health care reform is needed.
First, it’s important to clarify that most “non-urgent” surgeries (often called elective procedures) are not optional: Rather, they are medically necessary treatments scheduled or planned in advance, including hip and knee surgeries, and cardiac bypass and stent procedures. In B.C., these cancellations have already had fatal consequences. According to the B.C. government, the backlog is “more significant than anything we have ever faced.” While likely true, B.C.’s health care system faced major challenges before COVID-19.
For example, before the outbreak, British Columbians waited an average 12.7 weeks in 2019 to see a specialist after a referral from a general practitioner, then another 11.3 weeks to receive treatment after a consultation with a specialist for a total of 24 weeks. In 2019, these delays left 166,195 patients in the province waiting to receive treatment after seeing a specialist.
The knee-jerk response from governments across the country, including in B.C., is often to spend more money on health care. Given the rapid deterioration in government finances owing to the pandemic, however, this isn’t realistic; indeed, B.C.’s budget deficit is projected to reach $8.8-billion this year, as debt continues to rise sharply. It’s among many provinces struggling with deficits and mounting debt.
Federal finances seem to be in even worse shape than those provinces. The Parliamentary Budget Officer estimated in April that Ottawa’s deficit would eclipse $252-billion this year. This is the highest level on record and the forecast doesn’t include billions in additional spending announced over the course of the pandemic.
But even if governments could afford to spend more on health care, it’s not clear that increased spending would improve the system. Even in the pre-COVID-19 world, there was mounting evidence that Canada spends more on its universal health care system compared with other universal countries, while still performing poorly in some key areas.
For example, despite being one of the highest-spending universal countries in the Organisation for Economic Co-operation and Development (as a percentage of the economy), in 2017, Canada ranked low on the number of doctors (2.8 per 1,000, ranking 26th of 28), acute care beds (2.0 per 1,000, ranking 26th of 27), MRIs (10.4 per million, ranking 21st of 26) and CT scanners (15.9 per million, ranking 21st of 27) on an age-adjusted basis.
In contrast, countries such as Australia are also struggling to clear their elective surgery backlogs. But Australia has more doctors (4.0 per 1,000, ranking 6th of 28), MRIs (15.4 per million, ranking 11th of 26) and CT scanners (69.9 per million, ranking 2nd of 27) than Canada, after adjusting for age. And fewer Australians (8 per cent) were waiting four months or longer for elective surgery than Canadians (18 per cent) in 2016, the latest year of comparable data.
So, why the disparities between countries?
Simply put, other universal health care systems embrace the private sector, to varying degrees. Australia, for example, uses parallel private health care to augment its public system, allowing physicians to practise in both the public and private sectors, while contracting out the delivery of services to private hospitals. In Canada, we limit or effectively prohibit private-sector involvement in a significant portion of our health care system.
B.C.’s COVID-19 backlog response will include limited partnership with private clinics, however – and that’s a good thing. This type of initiative has precedents in Canada. In 2010, the aptly-named Saskatchewan Surgical Initiative used private clinics to provide publicly-funded surgeries and help Saskatchewan lower its wait times from Canada’s longest (28.8 weeks in 2008) to the shortest by 2015 (13.6 weeks). It’s also worthwhile to note that private clinics in Saskatchewan provided services at a lower cost per procedure than public hospitals.
The impact of COVID-19 on the provincial health care system underscores the need for greater flexibility to increase treatment options for patients within a universal framework. Simply throwing more money at the system is not a viable solution.
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