Policymakers in Ottawa and Edmonton maintain a poor health care system

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By Nadeem Esmail

To say that Albertans, and indeed all Canadians, are getting little value for their money in healthcare is a gross understatement. In reality, Canada remains among the countries that spend the most on health care in the developed world, in exchange for one of the least accessible universal health care systems. And while Canadians are increasingly open to meaningful reforms, policymakers are largely clinging to their outdated approach of more money, platitudes and little real change.

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In 2021 (the latest year of available data), among high-income countries with universal healthcare, Canada spent the largest proportion of its economy on healthcare (after adjusting for age differences between countries). For that level of world-class spending, Canada ranked 28th in physician availability, 23rd in hospital beds, 25th in MRI scanners, and 26th in CT scanners. And we rank last in wait times for specialty care and non-emergency surgeries.

This dismal performance has been consistent since at least the early 2000s, with Canada regularly recording top-ranked spending alongside bottom-ranked performance in access to health care.

At the provincial level, Albertans are no better off. Alberta’s health care system ranks as one of the most expensive in Canada per person (after adjusting for population age and sex), while wait times in Alberta were 21 per cent longer than average national in 2023.

And what are governments doing about our failing healthcare system? It doesn’t sound like much, other than another multi-million dollar federal spending commitment (by the federal government) and some bureaucratic changes (by the provincial government) combined with grandiose statements about how this will finally solve the health care crisis.

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But people don’t believe it anymore. Canadians increasingly understand that more money for an already expensive and failing system is not the answer, and they are increasingly open to reforms based on countries with higher performance in universal health care where the public system is more dependent on private companies and entrepreneurs to provide publicly funded services. . In fact, according to a recent survey, more than six in 10 Canadians agree that Canada should emulate other countries that allow private management of public hospitals, and more than half of those surveyed would like greater access to care provided by entrepreneurs.

What prevents these reforms?

In a word, Ottawa. The large and growing federal cash transfers so often applauded by premiers actually prevent provinces from innovating and experimenting with more successful health care policies. Because? Because to receive federal transfers, provinces must comply with the terms and conditions of the Canada Health Act, which prescribes often vaguely defined federal preferences for health policy and explicitly rejects certain reforms such as cost-sharing (where Patients pay fees for some services, with protections for low-income people).

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That threat of financial penalty deters provinces from following the examples of countries that provide more timely universal access to quality care, such as Germany, Switzerland, Australia and the Netherlands. These countries follow the same plan, which includes patient sharing of the costs of medical and hospital services (again, with protections for vulnerable populations, including low-income people), private competition in providing services universally accessible with money by following patients to hospitals and surgical clinics and allowing private purchases of care. However, if Alberta were to adopt this plan, which has served patients in these other countries so well, it would risk losing billions in healthcare transfers from Ottawa.

Finally, provinces have apparently forgotten the lesson of Saskatchewan’s surgical initiative, which ran from 2010 to 2014. That initiative, which included outsourcing publicly funded surgeries to private clinics, reduced waiting lists in Saskatchewan from the highest in the country to the shortest. . And when the initiative ended, wait times began to grow again.

The simple reality of healthcare in all provinces, including Alberta, is that the government system is failing despite world-class pricing. The solutions to this problem are known and increasingly desired by Canadians. Ottawa just needs to get out of the way and allow the provinces to genuinely reform the way we fund and deliver universal healthcare.

Nadeem Esmail is a senior fellow at the Fraser Institute.

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