OP-ED: Want to know the real reason Canada’s health care system is failing?

It’s not about money. It’s about the rules shaping how Canada’s health care system works.

Source: Wikimedia Commons

By: Conrad Eder

Canada’s health care system isn’t failing because it lacks funding or public support. It’s failing because governments have tied it to restrictive rules that block private medical options used in other developed countries to deliver timely care.

Canada spends close to $400 billion a year on health care, placing it among the highest-spending countries in the Organization for Economic Co-operation and Development. Yet the system continues to struggle with some of the longest wait times, the fewest doctors per capita and among the lowest numbers of hospital beds in the OECD. This is despite decades of spending increases, including growth of 4.5 per cent in 2023 and 5.7 per cent in 2024, according to the Canadian Institute for Health Information.

Public confidence that spending alone will fix the problem is eroding. Median health care wait times reached 30 weeks in 2024, up from 27.7 weeks in 2023 and 27.4 weeks in 2022, according to annual surveys by the Fraser Institute.

Politicians still tout universal health care as a source of national pride, and 74 per cent of Canadians agree. Yet only 56 per cent are satisfied with the system. Canadians value universality in principle but are increasingly frustrated with how it works in practice.

The problem is not universal health care itself, but Canada’s uniquely restrictive version of it. In most provinces, laws prevent physicians from working in both public and private systems and prohibit private insurance for medically necessary services covered by medicare. These constraints do not exist in most other universal health care systems.

The United Kingdom, France, Germany and the Netherlands all guarantee universal coverage, yet deliver better access to care. In Germany, public and private hospitals operate side by side. In France, universal insurance covers procedures in both public hospitals and private clinics. In the Netherlands, health insurance is privately delivered but universally mandated. In the United Kingdom, doctors working in public hospitals are allowed to maintain private practices.

These systems preserve universality while expanding choice, absorbing demand and reducing wait times. Only 26 per cent of Canadians can get same-day or next-day appointments with their family doctor, compared to 54 per cent of Dutch and 47 per cent of English patients. When specialist care is needed, 61 per cent of Canadians wait more than a month, compared to 25 per cent of Germans. For elective surgery, 90 per cent of French patients undergo procedures within four months, compared to 62 per cent of Canadians.

If other countries can deliver timely care without abandoning universal coverage, so can Canada. Two reforms, inspired by international practice, would improve access while preserving universality.

First, physicians should be allowed to practise in both public and private settings. This flexibility encourages doctors to spend more time providing care and expands system capacity, while private options absorb demand that would otherwise strain public resources.

Second, private insurance for medically necessary services should be permitted. This would give Canadians an affordable way to access care options that suit their needs, empower patients and support a more responsive health care system.

These proposals are not radical. They are standard practice across the OECD. Alberta has already taken a step by allowing some physicians to work in both systems through its dual-practice model. Other provinces should follow and remove remaining barriers to private insurance for medically necessary services, transforming private care from a luxury into a practical option for Canadian families.

Canadians take pride in their health care system. That pride should inspire reform, not prevent it. The crisis facing Canadian health care is real, driven by self-imposed constraints that prevent the system from delivering the timely care Canadians deserve.

Policymakers can preserve universal health care, but doing so will require learning from systems that deliver both universality and access—something Canada’s current model does not.

Conrad Eder is a policy analyst at the Frontier Centre for Public Policy.