Commentary
By Mackenzie Moir
According to a survey from earlier this year, 1.2 million patients in British Columbia were waiting to see a specialist, and only 11 percent of specialists felt that patients had adequate access to specialist care.
While distressing, these results are not new.
Last year, across 12 specialties (including orthopedic and neurosurgeries), patients in B.C. faced a median wait of 29.5 weeks between seeing a specialist and receiving treatment—the longest total wait in the province since measurements began more than 30 years ago.
Waitlists are not, however, an inevitable consequence of universal health care.
In 2023, data from nine countries with universal healthcare showed that Canada ranked near or at the bottom for wait times for specialists and non-emergency treatment. For instance, for patients who waited more than one month to see a specialist, Canada ranked 8th, far behind top-performing countries such as the Netherlands, Switzerland and Germany.
The results were even worse for non-emergency surgery. More than 58 percent of Canadians reported waiting more than two months for non-emergency surgery in 2023 compared to approximately 20 percent to 21 percent in the Netherlands, Germany and Switzerland. Clearly, other countries with universal health care have figured out ways to avoid long wait times for medical treatment.
So, what do these countries do differently?
Let’s first start with how hospitals are paid. Many successful universal health-care countries, such as Switzerland, the Netherlands and Germany, pay their hospitals for the actual services they provide. In contrast, hospitals in B.C. receive a set budget each year. This means that patients are more likely to be seen as costs to be minimized, whereas hospitals in these other countries are more likely to see patients as a source of revenue.
In other words, hospitals in B.C. are incentivized to minimize the number of patients they treat, while hospitals that are paid for the services they provide are incentivized to provide more services.
Changing the way we pay our hospitals would create a powerful incentive for them to treat more patients. Indeed, Quebec is implementing this reform so that all hospital payments are done this way by 2027/28.
To shorten wait times, the B.C. government could also expand the use of “pooling access” for specialists. Instead of being referred to a specific specialist known to your family doctor, you would instead be referred to a service that connects you with either the first available specialist in your area or the specialist of your choice.
By offering the choice of many specialists instead of just one, the B.C. government could shorten wait times for specialist care. Other Canadian provinces, including Saskatchewan, have used this approach with great success.
B.C.’s health-care system continues to fail to provide timely care to patients. Thankfully, there are reform options based on real-world experience that could materially improve health care for British Columbians and their families.
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