It seems that Alberta Premier Danielle Smith has a propensity for putting forward different policy models that attract criticism from those who want to resist change of any kind. Earlier this week, this happened again when Alberta was reported to be considering a different way of permitting doctors to work in the province. The draft legislation, which has not yet been finalized, discusses the possibility of having three different categories of doctors – those who choose to work exclusively in the public sector, those who work exclusively in the private sector and are not part of the public healthcare system, and doctors who decide to have a foot in both camps, spending time in both the public and private systems. The third category is the controversial one, opposed by the people that believe doctors should not be able to choose the hybrid approach as they claim it will take resources away from the public healthcare system.
The Canadian healthcare system has almost a mythical quality for some Canadians. It is true that at one time – a long time ago – our health care system was one of the best in the world. While some citizens still believe this is true, the factual evidence shows the exact opposite. Canadian health care ranks close to the bottom of developed countries with universal systems in terms of quality, while costing one of the highest amounts in the world.
A recent Fraser Institute study on universal healthcare systems around the world found that among the 31 countries in the study, all wealthy countries with universal systems, Canada ranked among the highest spenders but compared unfavourably on the availability of resources and access to services. The study was based on data from 2023, the most recent year for which comparable data were available.
In terms of spending as a percentage of GDP, Canada was the 3rd highest of the 31 countries. Despite the demands for more healthcare spending from a number of self-interested constituencies in Canada, the fact is we already spend much more for lower quality outcomes. Canada ranked 27th for the availability of doctors and 25th for hospital beds. As for the availability of MRI machines and CT scanners, Canada ranked 27th and 28th respectively.
With respect to the timeliness of care, Canada ranked last or close to last when considering factors such as the wait times involved in seeing a specialist and the ability to make a same- or next-day appointment when sick. Canada had the highest percentage of patients who waited two months or more for non-emergency surgery. These types of results have also been found in other international comparative studies as well. Clearly, there is much to be fixed in the Canadian system, and Canadians are not receiving value for the amount of money spent.
One of the problems in reforming Canadian healthcare is the persistence of myths that have no basis in fact yet continue to be stated as truth. Critics of any change to our healthcare system regularly state the problems with so-called “two-tier” healthcare, and pretend our current system is totally public. The reality, however, is that we already have lots of private sector care providers in the system – about 40 per cent – comprised of the many diagnostic labs and medical test clinics that exist in every province. Their costs are included in Canada’s universal system, and they have greatly improved efficiencies, convenience and access for patients.
There are also a growing number of private clinics providing non-emergency procedures such as joint replacements, hernia surgery and vision care. Some of these are within the universal framework and some require private payment if the patient so chooses. Some of the critics of the Alberta draft proposals have claimed that the notion of a doctor working in both the public and private sectors is some kind of new concept to Canada. There is no truth to this claim. This author had eye surgery a few years ago in a private clinic, paid for out of my pocket, by a top-notch surgeon who also worked in the public system. Why should this not be permitted? Part of the Alberta strategy is to incent doctors to locate there, as having the option to do some work in the private sector and increase their income is an attractive proposition. As for the claim that the “rich” will get better care because they can afford to pay in the private sector, that is already happening, so not really a threat.
The other compelling reason for structural change in our healthcare system is that people are currently dying or have worsening health issues as they have to wait for so long to get treatment. The think tank Second Street found that at least 15,474 Canadians died while on waiting lists between April 2023 and March 2024. An unknown number also had their conditions deteriorate because of long waits. This is totally unacceptable in a developed country such as Canada, especially considering all the tax dollars we spend on healthcare. Other countries with universal systems do much better, many at lower cost, and virtually all of them have a hybrid public/private system.
The case for a major restructuring of health are in Canada is overwhelming. We can’t permit special interest groups like healthcare unions to continue to tell lies to frighten Canadians into resisting the needed changes. We’ll have to wait and see what is in the final Alberta legislation when it is introduced. If this can spark a Canada-wide discussion of the realities of our healthcare system and what needs to be done to better serve Canadians, we will all owe Alberta our thanks. Continuing belief in a fantasy that has not existed for years does no one any favours, and just delays badly-needed reform.
She has published numerous articles in journals, magazines & other media on issues such as free trade, finance, entrepreneurship & women business owners. Ms. Swift is a past President of the Empire Club of Canada, a former Director of the CD Howe Institute, the Canadian Youth Business Foundation, SOS Children’s Villages, past President of the International Small Business Congress and current Director of the Fraser Institute. She was cited in 2003 & 2012 as one of the most powerful women in Canada by the Women’s Executive Network & is a recipient of the Queen’s Silver & Gold Jubilee medals.
