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Fraser Institute

Canadians want major health-care reform now

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From the Fraser Institute

By Mackenzie Moir

Tragic stories of multiyear waits for patients are now a Canadian news staple. Is it any wonder, therefore, that a new Navigator poll found almost two-thirds of Canadians experienced (either themselves or a family member) unreasonably long for access to health care. The poll also found that 73 per cent of respondents agree the system needs major reform.

This situation shouldn’t surprise anyone. Last year Canadians could expect a 27.7-week delay for non-emergency treatment. Nearly half this time (13.1 weeks) was spent waiting for treatment after seeing a specialist—that’s more than one month longer than what physicians considered reasonable.

And it’s not as though these unreasonable waits are simple inconveniences for patients; they can have serious consequences including continued pain, psychological distress and disability. For many, there are also economic consequences for waiting due to lost productivity or wages (due to difficulty or inability to work) or for Canadians who pay for care in another country.

Canadians are also experiencing longer delays than their European and Australian universal health-care peers. In 2020, Canadians were the least likely (62 per cent) to report receiving non-emergency surgical treatment in under four weeks compared to Germans (99 per cent) and Australians (72 per cent).

What do they do differently? Put simply, they approach universal care in a different way than we do.

In particular, these countries all have a sizeable and well-integrated private sector that helps deliver universal care including surgical care. For example, in 2021, 45 per cent of hospitals in Germany (a plurality) were private for-profit. And 99 per cent of German hospital beds are accessible to those covered under the country’s mandatory insurance scheme. In Australia, governments regularly contract with private hospitals to provide surgical care, with private facilities handling 41 per cent of all hospital services in 2021/22.

These universal health-care countries also tend to fund their hospitals differently.

Governments in Canada primarily fund hospitals through “global budgets.” With a fixed budget set at the beginning of the year, this funding method is unconnected to the level of services provided. Consequently, patients are treated as costs to be minimized.

In contrast, hospitals in most European countries and Australia are funded on the basis of their activity. As a result, because they are paid for services they actually deliver, hospitals are incentivized to provide higher volumes of care.

The data are clear. Canadian patients are frustrated with their health-care system and have an appetite for change. We stand to learn from other countries who maintain their universal coverage while delivering health care faster than in Canada.

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Economy

Affordable housing out of reach everywhere in Canada

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From the Fraser Institute

By Steven Globerman, Joel Emes and Austin Thompson

According to our new study, in 2023 (the latest year of comparable data), typical homes on the market were unaffordable for families earning the local median income in every major Canadian city

The dream of homeownership is alive, but not well. Nearly nine in ten young Canadians (aged 18-29) aspire to own a home—but share a similar worry about the current state of housing in Canada.

Of course, those worries are justified. According to our new study, in 2023 (the latest year of comparable data), typical homes on the market were unaffordable for families earning the local median income in every major Canadian city. It’s not just Vancouver and Toronto—housing affordability has eroded nationwide.

Aspiring homeowners face two distinct challenges—saving enough for a downpayment and keeping up with mortgage payments. Both have become harder in recent years.

For example, in 2014, across 36 of Canada’s largest cities, a 20 per cent downpayment for a typical home—detached house, townhouse, condo—cost the equivalent of 14.1 months (on average) of after-tax income for families earning the median income. By 2023, that figure had grown to 22.0 months—a 56 per cent increase. During the same period for those same families, a mortgage payment for a typical home increased (as a share of after-tax incomes) from 29.9 per cent to 56.6 per cent.

No major city has been spared. Between 2014 and 2023, the price of a typical home rose faster than the growth of median after-tax family income in 32 out of 36 of Canada’s largest cities. And in all 36 cities, the monthly mortgage payment on a typical home grew (again, as a share of median after-tax family income), reflecting rising house prices and higher mortgage rates.

While the housing affordability crisis is national in scope, the challenge differs between cities.

In 2023, a median-income-earning family in Fredericton, the most affordable large city for homeownership in Canada, had save the equivalent of 10.6 months of after-tax income ($56,240) for a 20 per cent downpayment on a typical home—and the monthly mortgage payment ($1,445) required 27.2 per cent of that family’s after-tax income. Meanwhile, a median-income-earning family in Vancouver, Canada’s least affordable city, had to spend the equivalent of 43.7 months of after-tax income ($235,520) for a 20 per cent downpayment on a typical home with a monthly mortgage ($6,052) that required 112.3 per cent of its after-tax income—a financial impossibility unless the family could rely on support from family or friends.

The financial barriers to homeownership are clearly greater in Vancouver. But, crucially, neither city is truly “affordable.” In Fredericton and Vancouver, as in every other major Canadian city, buying a typical home with the median income produces a debt burden beyond what’s advisable. Recent house price declines in cities such as Vancouver and Toronto have provided some relief, but homeownership remains far beyond the reach of many families—and a sharp slowdown in homebuilding threatens to limit further gains in affordability.

For families priced out of homeownership, renting doesn’t offer much relief, as rent affordability has also declined in nearly every city. In 2014, rental rates for the median-priced rental unit required 19.8 per cent of median after-tax family income, on average across major cities. By 2023, that figure had risen to 23.5 per cent. And in the least affordable cities for renters, Toronto and Vancouver, a median-priced rental required more than 30 per cent of median after-tax family income. That’s a heavy burden for Canada’s renters who typically earn less than homeowners. It’s also an added financial barrier to homeownership— many Canadian families rent for years before buying their first home, and higher rents make it harder to save for a downpayment.

In light of these realities, Canadians should ask—why have house prices and rental rates outpaced income growth?

Poor public policy has played a key role. Local regulations, lengthy municipal approval processes, and costly taxes and fees all combine to hinder housing development. And the federal government allowed a historic surge in immigration that greatly outpaced new home construction. It’s simple supply and demand—when more people chase a limited (and restricted) supply of homes, prices rise. Meanwhile, after-tax incomes aren’t keeping pace, as government policies that discourage investment and economic growth also discourage wage growth.

Canadians still want to own homes, but a decade of deteriorating affordability has made that a distant prospect for many families. Reversing the trend will require accelerated homebuilding, better-paced immigration and policies that grow wages while limiting tax bills for Canadians—changes governments routinely promise but rarely deliver.

Steven Globerman

Senior Fellow and Addington Chair in Measurement, Fraser Institute

Joel Emes

Senior Economist, Fraser Institute

Austin Thompson

Senior Policy Analyst, Fraser Institute
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Agriculture

Canada’s air quality among the best in the world

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From the Fraser Institute

By Annika Segelhorst and Elmira Aliakbari

Canadians care about the environment and breathing clean air. In 2023, the share of Canadians concerned about the state of outdoor air quality was 7 in 10, according to survey results from Abacus Data. Yet Canada outperforms most comparable high-income countries on air quality, suggesting a gap between public perception and empirical reality. Overall, Canada ranks 8th for air quality among 31 high-income countries, according to our recent study published by the Fraser Institute.

A key determinant of air quality is the presence of tiny solid particles and liquid droplets floating in the air, known as particulates. The smallest of these particles, known as fine particulate matter, are especially hazardous, as they can penetrate deep into a person’s lungs, enter the blood stream and harm our health.

Exposure to fine particulate matter stems from both natural and human sources. Natural events such as wildfires, dust storms and volcanic eruptions can release particles into the air that can travel thousands of kilometres. Other sources of particulate pollution originate from human activities such as the combustion of fossil fuels in automobiles and during industrial processes.

The World Health Organization (WHO) and the Canadian Council of Ministers of the Environment (CCME) publish air quality guidelines related to health, which we used to measure and rank 31 high-income countries on air quality.

Using data from 2022 (the latest year of consistently available data), our study assessed air quality based on three measures related to particulate pollution: (1) average exposure, (2) share of the population at risk, and (3) estimated health impacts.

The first measure, average exposure, reflects the average level of outdoor particle pollution people are exposed to over a year. Among 31 high-income countries, Canadians had the 5th-lowest average exposure to particulate pollution.

Next, the study considered the proportion of each country’s population that experienced an annual average level of fine particle pollution greater than the WHO’s air quality guideline. Only 2 per cent of Canadians were exposed to fine particle pollution levels exceeding the WHO guideline for annual exposure, ranking 9th of 31 countries. In other words, 98 per cent of Canadians were not exposed to fine particulate pollution levels exceeding health guidelines.

Finally, the study reviewed estimates of illness and mortality associated with fine particle pollution in each country. Canada had the fifth-lowest estimated death and illness burden due to fine particle pollution.

Taken together, the results show that Canada stands out as a global leader on clean air, ranking 8th overall for air quality among high-income countries.

Air Quality infographic

Canada’s record underscores both the progress made in achieving cleaner air and the quality of life our clean air supports.

Annika Segelhorst

Junior Economist

Elmira Aliakbari

Director, Natural Resource Studies, Fraser Institute
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