Over the past 30 years, Canada has slid in the global rankings in terms of how much it spends on healthcare (from fourth in the world to twelfth), and the life expectancy of Canadians has declined accordingly (from seventh in the world to sixteenth, and projected to drop further to 27th in the world by 2040).
According to the OECD, Canada now ranks 26th of 31 high-income nations when it comes to physicians per capita. Among countries with universal coverage, Canada ranks among the lowest in terms of number of hospital beds and medical technologies. And as Canadians who can afford it increasingly turn to private-pay healthcare providers, doctors are leaving the public system, making conditions even worse for the patients who rely on that system. Canada’s physicians are already at a breaking point, and as burnout, stress, and dissatisfaction mount, this is bound to further compromise the quality of care.
Canada’s investment in its healthcare infrastructure has not kept pace with population growth, and Canadians are feeling the consequences of that disinvestment, with increasingly dire outcomes.
Barriers to primary and preventive care access
According to a 2023 report from the Fraser Institute, the median wait time for medically necessary diagnostic or surgical procedures in Canada is 27.7 weeks. The think tank SecondStreet.org estimates that 17,000 patients across Canada died while waiting for surgery or diagnostic scans in 2022-23. Conditions have deteriorated to the point that 42% of Canadians said in a recent Ipsos poll that they would travel to the U.S. and pay out of pocket for routine healthcare and 38% would do the same for emergency care.
One in six Canadians lacks a primary care physician, according to a 2023 survey by the OurCare initiative. Patients may not know they have chronic conditions such as diabetes or hypertension, leading to delays in treatment—ultimately resulting in higher expenses and worse outcomes for patients. Barriers to access tend to hit rural and underserved communities hardest, since these communities tend to have fewer choices to begin with, and disinvestment may exacerbate existing disparities.
Delays in care lead to worse outcomes
For every 100,000 people who lack a primary care physician and therefore don’t receive the recommended preventive care, 40 unnecessary deaths occur each year, Dr. Mark Roper—who leads McGill University Health Center’s primary care division—told Bloomberg News. Calculate that against the number of Canadians who lack primary care assess—an estimated 4 million adults—and the urgency of the problem becomes readily apparent. Conversely, adding capacity to the primary care system can have downstream effects, resulting in savings that multiply the return on investment.
When patients get sicker before they seek treatment, that has a ripple effect, straining emergent care systems. After patient deaths while waiting for care drew widespread attention to the topic last year, the Canadian Medical Association released a statement calling for urgent action to address the overcrowding crisis in Canada’s hospital emergency rooms.
Political will for finding solutions
The stark reality of Canada’s crumbling system carries one silver lining: Canadians are hungry for solutions and are likely to support significant reforms. In a recent public opinion survey, healthcare ranked as the third most important issue for all Canadians (and second most important for women).
This is a complex problem that cannot be solved overnight—and no single solution will fix it. Moving the needle in a meaningful way is likely to involve some combination of investment in:
Technology, equipment, and facilities
Education and personnel
Strategy and planning
Funding to support access, especially for preventive care and management of chronic conditions
Addressing Canada’s healthcare challenges will require a multipronged approach and sustained attention over a period of years or decades to make headway. But a country that is not healthy cannot be a world leader in any sphere—economic, political, scientific. The cost and effort that will be needed to fix the healthcare system are well worth undertaking for the sake of Canadians’ well-being.