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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.

2025 Federal Election

Housing starts unchanged since 1970s, while Canadian population growth has more than tripled

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From the Fraser Institute

By: Austin Thompson and Steven Globerman

The annual number of new homes being built in Canada in recent years is virtually the same as it was in the 1970s, despite annual population growth
now being three times higher, finds a new study published today by the Fraser Institute, an independent, non-partisan Canadian public policy think tank.

“Despite unprecedented levels of immigration-driven population growth following the COVID-19 pandemic, Canada has failed to ramp up homebuilding sufficiently to meet housing demand,” said Steven Globerman, Fraser Institute senior fellow and co-author of The Crisis in Housing Affordability: Population Growth and Housing Starts 1972–2024.

Between 2021 and 2024, Canada’s population grew by an average of 859,473 people per year, while only 254,670 new housing units were started annually. From 1972 to 1979, a similar number of new housing units were built—239,458—despite the population only growing by 279,975 people a year.

As a result, more new residents are competing for each new home than in the past, which is driving up housing costs.

“The evidence is clear—population growth has been outpacing housing construction for decades, with predictable results,” Globerman said.

“Unless there is a substantial acceleration in homebuilding, a slowdown in population growth, or both, Canada’s housing affordability crisis is unlikely to improve.”

The Crisis in Housing Affordability: Population Growth and Housing Starts 1972–2024

  • Canada experienced unprecedented population growth following the COVID-19 pandemic without a commensurately large increase in new homebuilding.
  • The imbalance between population growth and new housing construction is reflected in a significant gap between housing demand and supply, which is driving up housing costs.
  • Canada’s population grew by a record 1.23 million new residents in 2023 almost entirely due to immigration. That growth was more than double the pre-pandemic record set in 2019.
  • Population growth slowed to 951,517 in 2024, still well above any year before 2023.
  • Nationally, construction began on about 245,367 new housing units in 2024, down from a recent high of 271,198 starts in 2021—Canada’s annual number of housing starts peaked at 273,203 in 1976.
  • Canada’s annual number of housing starts regularly exceeded 200,000 in past decades, when absolute population growth was much lower.
  • In 2023, Canada added 5.1 new residents for every housing unit started, which was the highest ratio over the study’s timeframe and well above the average rate of 1.9 residents for every unit started observed over the study period (1972–2024).
  • This ratio improved modestly in 2024, with 3.9 new residents added per housing start. However, the ratio remains far higher than at any point prior to the COVID-19 pandemic.
  • These national trends are broadly mirrored across all 10 provinces, where annual population growth relative to housing starts is, to varying degrees, elevated when compared to long-run averages.
  • Without an acceleration in homebuilding, a slowdown in population growth, or both, Canada’s housing affordability crisis will likely persist.

Austin Thompson

Senior Policy Analyst, Fraser Institute

Steven Globerman

Senior Fellow and Addington Chair in Measurement, Fraser Institute
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Education

Schools should focus on falling math and reading skills—not environmental activism

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From the Fraser Institute

By Michael Zwaagstra

In 2019 Toronto District School Board (TDSB) trustees passed a “climate emergency” resolution and promised to develop a climate action plan. Not only does the TDSB now have an entire department in their central office focused on this goal, but it also publishes an annual climate action report.

Imagine you were to ask a random group of Canadian parents to describe the primary mission of schools. Most parents would say something along the lines of ensuring that all students learn basic academic skills such as reading, writing and mathematics.

Fewer parents are likely to say that schools should focus on reducing their environmental footprints, push students to engage in environmental activism, or lobby for Canada to meet the 2016 Paris Agreement’s emission-reduction targets.

And yet, plenty of school boards across Canada are doing exactly that. For example, the Seven Oaks School Division in Winnipeg is currently conducting a comprehensive audit of its environmental footprint and intends to develop a climate action plan to reduce its footprint. Not only does Seven Oaks have a senior administrator assigned to this responsibility, but each of its 28 schools has a designated climate action leader.

Other school boards have gone even further. In 2019 Toronto District School Board (TDSB) trustees passed a “climate emergency” resolution and promised to develop a climate action plan. Not only does the TDSB now have an entire department in their central office focused on this goal, but it also publishes an annual climate action report. The most recent report is 58 pages long and covers everything from promoting electric school buses to encouraging schools to gain EcoSchools certification.

Not to be outdone, the Vancouver School District (VSD) recently published its Environmental Sustainability Plan, which highlights the many green initiatives in its schools. This plan states that the VSD should be the “greenest, most sustainable school district in North America.”

Some trustees want to go even further. Earlier this year, the British Columbia School Trustees Association released its Climate Action Working Group report that calls on all B.C. school districts to “prioritize climate change mitigation and adopt sustainable, impactful strategies.” It also says that taking climate action must be a “core part” of school board governance in every one of these districts.

Apparently, many trustees and school board administrators think that engaging in climate action is more important than providing students with a solid academic education. This is an unfortunate example of misplaced priorities.

There’s an old saying that when everything is a priority, nothing is a priority. Organizations have finite resources and can only do a limited number of things. When schools focus on carbon footprint audits, climate action plans and EcoSchools certification, they invariably spend less time on the nuts and bolts of academic instruction.

This might be less of a concern if the academic basics were already understood by students. But they aren’t. According to the most recent data from the Programme for International Student Assessment (PISA), the math skills of Ontario students declined by the equivalent of nearly two grade levels over the last 20 years while reading skills went down by about half a grade level. The downward trajectory was even sharper in B.C., with a more than two grade level decline in math skills and a full grade level decline in reading skills.

If any school board wants to declare an emergency, it should declare an academic emergency and then take concrete steps to rectify it. The core mandate of school boards must be the education of their students.

For starters, school boards should promote instructional methods that improve student academic achievement. This includes using phonics to teach reading, requiring all students to memorize basic math facts such as the times table, and encouraging teachers to immerse students in a knowledge-rich learning environment.

School boards should also crack down on student violence and enforce strict behaviour codes. Instead of kicking police officers out of schools for ideological reasons, school boards should establish productive partnerships with the police. No significant learning will take place in a school where students and teachers are unsafe.

Obviously, there’s nothing wrong with school boards ensuring that their buildings are energy efficient or teachers encouraging students to take care of the environment. The problem arises when trustees, administrators and teachers lose sight of their primary mission. In the end, schools should focus on academics, not environmental activism.

Michael Zwaagstra

Senior Fellow, Fraser Institute
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