More money won’t solve B.C.’s health-care crisis

According to John Rustad, leader of the Conservative Party of British Columbia, the province’s health-care system “is collapsing” and “throwing more money at this problem won’t solve it.” The good and bad news is—he’s right.

From 2016/17, which marks the end of an era of relative fiscal restraint in the province, to 2023/34, health-care spending in B.C. grew by 13.9 per cent (after adjusting for population growth and inflation). And based on estimates for 2023, the province spent more on health care per person ($6,045) than any other province outside Atlantic Canada. Given that Canada remains a relatively high spender among universal health-care countries, B.C. is a high spender in a high-spending country.

At the same time, in 2023 (the latest year of available data), a typical patient in B.C. waited 14.1 weeks for an appointment with a specialist after referral from their family doctor—then an additional 13.7 weeks for treatment after that consultation. This combined 27.7-week wait was longer than the 26.6 week wait in 2017 and much longer than the 10.4-week wait in 1993 when wait times were first measured for all 10 provinces.

More broadly, Canada is one of the highest spenders on health care (as a percentage of the economy) in the developed world, yet ranks near the bottom for the number of doctors, diagnostic technologies and hospital beds. And we have some of the longest delays for access to specialist and non-emergency surgical care among universal health-care countries.

Clearly, the strategy of higher spending hasn’t worked. What we need is policy reform.

Fortunately, we don’t need to recreate the wheel. Other universal health-care countries spend less (or comparably) on health care than we do (as a share of the economy) while outperforming us on key metrics. For instance, Australia, Germany and Switzerland have more physicians, hospital beds, key diagnostic technologies (e.g. MRIs) than Canada, and larger proportions of their populations access specialists and non-emergency surgeries in a timely manner.

These countries do many things differently, including allowing the private sector to help deliver publicly-funded services to patients. In Australia, for example, private hospitals have provided publicly funded care since the early 1990s. In 2021/22, 41 per cent of all hospital care in Australia took place in private facilities.
 
But B.C. policymakers need not look abroad for examples on how to expand access and reduce wait times. An initiative in Saskatchewan, which included the use of private clinics, helped reduce wait times in that province from 26.5 weeks in 2010 to 14.2 weeks by 2014. And these private clinics in Saskatchewan delivered surgeries at a cost 26 per cent lower (on average) than their public-sector equivalents.

Outside of Canada, it’s also common for universal health-care countries to pay hospitals based on the volume of services they provide. Yet in most of Canada including B.C., hospitals operate on pre-set budgets each year, where funding is disconnected from the number of services provided, and patients are viewed as costs to be minimized. But if we tied funding to the delivery of services—like they do in other universal health-care countries—we would incentivize hospitals to deliver care to more patients.

Throwing more money at B.C.’s health-care system is simply fuelling a failed approach. Instead, the province’s health-care system needs fundamental reform. Providing relief for B.C. patients should be a nonpartisan solution that everyone can support.