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Fraser Institute

Other countries with universal health care don’t have Canada’s long wait times

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From the Fraser Institute

By Mackenzie Moir and Bacchus Barua

Unfortunately it’s now very common to see stories about how long provincial wait times for medical care are driving patients to seek care elsewhere, often at great personal cost. Take the recent case of the  Milburns in Manitoba who, after waiting years for a knee surgery, are now considering selling their home and moving to Alberta just to get on a potentially shorter public wait list.

Patients in Manitoba could expect to wait a median of 29 weeks to see an orthopedic specialist after a referral from a family physician, then they still faced a median 24.4 week wait to get treatment. In other words, the total typical wait for orthopedic surgery in the province is more than one year at 53.4 weeks. Remember, that’s a median measure, which means some patients wait much longer.

Unfortunately, the Milburns are unlikely to get more timely care on the public wait list in Alberta. At 64.1 weeks, the total median wait for orthopedic care in Alberta was actually longer than in Manitoba. And this doesn’t include the time it takes for provincial coverage to activate for a new provincial resident, or the time it will take to find a new family doctor and get the necessary tests, scans and referrals.

To get more timely care, the Milburns are left with unenviable options. Because they’re insured by Manitoba’s public health-care plan, paying for covered care out of pocket is restricted. They can, however, pay for and receive care privately in other provinces as uninsured visitors (i.e. not move there permanently). Specifically, certain provinces have “exemptions” that allow physicians to charge out-of-province patients directly to provide these procedures privately.

Alternatively, the Milburns could leave Canada and travel even further from home to receive timely care abroad.

But it doesn’t have to be this way.

Long wait times are not the necessary price Canadians must pay for universal coverage. In fact, Canada is one of 30 high-income countries with universal health care. Other countries such as Switzerland, the Netherlands, Germany and Australia have much shorter wait times. For example, only 62 per cent of Canadians reported access to non-emergency surgery in less than four months in 2020 compared to 99 per cent of Germans, 94 per cent of Swiss and 72 per cent of Australians.

The difference? These countries approach health care in a fundamentally different way than us. One notable difference is their attitude towards the private sector.

In Germany, patients can seek private care while still insured by the public system or can opt out and purchase regulated private coverage. These approaches (universal, privately paid or privately insured) are able to deliver rapid access to care. The Swiss simply mandate that patients purchase private insurance in a regulated-but-competitive marketplace as part of their universal scheme. Lower-income families receive a subsidy so they can participate on a more equal footing in the competitive marketplace to obtain the insurance that best fits their needs.

Perhaps the most direct comparator to Canada is Australia—not just geographically, but because it also primarily relies on a tax-funded universal health-care system. However, unlike Canada, individuals can purchase private insurance to cover (among other things) care received as a private patient in a public or private hospital, or simply pay for their private care directly if they choose. In 2021/22 more than two-thirds (70 per cent) of non-emergency admissions to a hospital involving surgery (both publicly and privately funded) took place in a private facility.

Of course, these faster-access countries share other differences in attitudes to universal health-care policy including requirements to share the cost of care for patients and funding hospitals on the basis of activity (instead of Canada’s outdated bureaucratically-determined budgets). A crucial difference, however, is that patients are not generally prevented from paying privately for health care in their home province (or canton or state) in any of these countries.

Without fundamental reform, and as provincial systems continue to struggle to provide basic non-emergency care, we’ll continue to see more stories like the Milburn’s. Without reform, many Canadians will continue to be forced to make similarly absurd decisions to get the care they need, rather than focusing on treatment and recovery.

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Automotive

Electric vehicle sales mandates doomed to fail

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From the Fraser Institute

By Julio Mejía and Elmira Aliakbari

Nearly 30 per cent of EV owners worldwide intend to switch back to internal combustion engine (ICE) vehicles.

According to new data released this week, electric vehicle (EV) sales in Europe plummeted by 36 per cent in Europe including a 69 per cent drop in Germany, the continent’s largest auto market. And according to a recent survey by McKinsey & Company, nearly 30 per cent of EV owners worldwide intend to switch back to internal combustion engine (ICE) vehicles. Clearly, in light of growing consumer hesitation and a global slowdown in EV sales, the ambitious timelines set by governments for the EV transition are increasingly at odds with market realities.

In Canada, the Trudeau government has mandated that all new passenger vehicles and light trucks must be zero-emission by 2035, with interim targets of 20 per cent by 2026 and 60 per cent by 2030. But only 8.1 per cent (139,521) of the 1.7 million new vehicles sold in Canada in 2023 were electric, according to Statistics Canada. And it takes an average of 55 days to sell an EV in Canada—33 days longer than in 2023 and four days more than a gasoline-powered car. To achieve the Trudeau government’s 2026 target, EV sales would need to more than double in just two years and increase more than sevenfold by 2030 (assuming no change in total vehicle sales). Such rapid growth within a short timeframe is questionable at best.

It’s a similar story in the United States where the Biden administration has mandated that nearly 60 per cent of new vehicles sold must be electric by 2032 even though demand in 2024 has been lighter than expected and nearly half of American EV owners say they’re likely to switch back to ICEs. In Europe, the United Kingdom and the European Union plan to ban the sale of new ICE vehicles by 2035 yet, as previously noted, EV sales are plummeting.

Some automakers have already responded to the realities of the EV market. In April, Tesla laid off 10 per cent of its global workforce. Ford announced it will cancel the production of an electric SUV, delay the production of an electric pickup truck, and postpone the start of EV production at its Oakville, Ontario plant by two years. General Motors abandoned its goal of producing 400,000 EVs by mid-2024 due to lower-than-expected sales and revealed in August it would delay the start of production at its battery plant in Indiana by about one year, pushing the timeline to 2027.

The EV transition also faces another major hurdle—a shortage of minerals for EV batteries that can only be addressed by opening a massive number of new mines in record time. According to a 2023 study, to meet international EV adoption mandates by 2030, the world would need 50 new lithium mines, 60 new nickel mines, 17 new cobalt mines, 50 new mines for cathode production, 40 new mines for anode materials, 90 new mines for minerals needed to produce battery cells, and 81 new mines for the body and motors of the EVs themselves, for a total of 388 new mines worldwide. For context, in 2021 there were only 340 metal mines operating in Canada and the U.S. combined.

Identifying, planning and constructing a mine is a slow process. For instance, lithium production timelines range from six to nine years and for nickel 13 to 18 years—both of these elements remain critical for EV batteries. Clearly, today’s aggressive government timelines for EV adoption clash with the realities of mineral mining.

The facts are undeniable. Governments can’t dictate consumer choices via mandate. The fantastic EV adoption timelines of the Trudeau government and other governments in the western world are increasingly out of touch with the realities of production and market demand. These governments have overestimated their ability to shape the auto industry, which is why EV mandates will fail.

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Alberta

Alberta government should reform hospital funding to help shorten wait times

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From the Fraser Institute

By Mackenzie Moir and Alicia Kardos

Other high-performing countries with universal health care (Australia, Germany, Switzerland) use “activity-based funding.” Under this model, hospitals receive funding based on the amount of care they provide.

Earlier this year, the Alberta Medical Association sounded the alarm on “rolling surgical outages,” patients diverted to other treatment sites, and the potential capping of services at major provincial hospitals. Unfortunately, the delays these problems create aren’t new to Albertans, as patients continue to face lengthy wait times.

According to the latest data, Albertan patients faced a median wait time of 33.5 weeks in 2022 for non-emergency medical treatment, a delay that was nearly six weeks longer than the national average, and three times longer than what patients in the province experienced in 1993 (when national estimates were first published).

When broken down, the wait in Alberta includes the first 16.4 weeks it takes for a patient to see a specialist after referral from their family doctor—then a second wait of 17.2 weeks to receive treatment after seeing that specialist. And these figures don’t account for the wait to see a GP in the first place, which is a significant issue in a rapidly growing province where remain without a family doctor.

Of course, we hear the predicable calls for more money. But in reality, spending more won’t get Albertans out of this problem. In a recent comparison of high-income countries with universal coverage, Canada (in 2021) was already one of the highest spenders on health care (as a share of their economy) while having some of the fewest doctors and hospital beds (after accounting for differences in population age among countries).

And when compared to nine other high-income countries in 2020, Canadians were found to have the longest waits for medical care. Specifically, Canadians were the least likely to report waiting under four months for non-emergency surgery (at 62 per cent) compared to higher-performing countries such as Australia (72 per cent), Switzerland (94 per cent) and Germany (99 per cent).

So what’s the solution?

In a word, reform. For example, Alberta could change the way it funds hospitals. Canada’s predominant approach is to provide hospitals a set amount of money each year, regardless of the level of services provided. This means that the money hospitals receive isn’t tied to the actual number of services they provide. This discourages hospitals from providing more care because each patient represents a drain on their budget rather than an opportunity.

In contrast, many other high-performing countries with universal health care (Australia, Germany, Switzerland) use “activity-based funding.” Under this model, hospitals receive funding based on the amount of care they provide. This creates a powerful incentive for hospitals to treat more patients, because each patient represents an opportunity for the hospital to earn more money.

Quebec decided in last year to fund all of its surgical procedures using this model, and now plans to expand the model to all hospital care by 2027/28. The Smith government has also taken some steps that lay the foundation for these types of reforms. This is good news for Albertans, if reform is actually on the way.

Across Canada, despite the availability of solutions, the status quo of long waits persists. Breaking from the past can be hard, but there may be hope on the horizon for patients in Alberta’s beleaguered and poorly performing health-care system.

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