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Should we blame single payer system for Canada’s long wait times?

Healthcare is a complicated system. And yet, when it comes to understanding how other countries run their healthcare, we can oversimplify the problems that other countries face and how to fix them. 

Repeatedly Canada has shown to have problems with long wait times to get medical care. The Commonwealth Fund is an organization that has been doing surveys for years to ask patients and doctors in 11 countries about their healthcare system. Canada has remained dead last in having the longest wait times. This problem has become a problem that we associate with Canada having a single payer model. Is it possible, though, for states in the U.S. to have a single payer model and avoid long wait times?

Quick Overview: Canada’s Single Payer System is Provincial, Not National

Canada is divided into 10 main provinces (like a state). Each province pays for its citizens’ medical care with local taxes and the Canadian federal government also gives a specific amount of money to each province annually to help pay for care. How that money is spent is largely up to the province itself. This would be similar to how Medicaid works in the U.S. 

While most hospitals in Canada are run by private companies, either for- or non-profit, and doctors are self-employed, the Canada Health Act requires provinces to supervise medical care to ensure it’s working for their population and to help control costs. 

Canada Dead Last in Long Wait Times

Canada Limits Available Doctors

Some provincial governments have influenced the number of overall doctors available for Canadian citizens to see in the hopes to control medical care costs. Provincial governments can’t control who hospitals and clinics hire, but they can control the number of resident positions where new doctors must train in order to become licensed. So they sometimes have cut funding for resident positions to limit available doctors and decide which areas they want the doctors trained - primary care vs. specialist training - to fill gaps. 

While the number of primary care doctors are low in Canada compared to the other countries surveyed, we actually have the same amount in the U.S. with similar wait times to see them. The main difference in the U.S. is we have almost 2x more specialists than primary care doctors. This difference has a big impact on wait times to see specialists. 

  Canada U.S.
Primary Care Drs. / 100,000 people 115 91.1
Specialists / 100,000 people 113 165
Able to Get Same-day/Next Day Appointment to See a Doctor or Nurse 41% of Canadians surveyed 48% of Americans surveyed
Took 6+ Days to See a Doctor 33% of Canadians surveyed 26% of Americans surveyed
<4 weeks to see a specialist 39% of Canadians surveyed 76% of Americans surveyed
2+ months to see a specialist 29% of Canadians surveyed 6% of Americans surveyed

Source: Canadian Medical Association Physician Statistics

              Agency for Healthcare Research and Quality

              The Commonwealth Fund International Survey Data

U.S Government Also Limits Medical Resident Positions

The U.S. federal government, through Medicare, also funds almost all of the residency positions for our doctors to finalize their medical training at hospitals. The government pays teaching hospitals for each resident and have capped the total residents they will pay for each year at 100,000 across the U.S. Medical schools just haven’t produced enough graduates to reach that cap yet.

What the federal government doesn’t control are the type of resident positions they will pay for. Hospitals, however, get reimbursed by the government and health insurance at higher rates for specialist care. They are financially incentivized to produce more, so it makes sense that they would.

Canada’s Long Wait Times at the Emergency Room

Unfortunately the survey did not update its results of emergency room wait times since 2007. However, organizations like Wait Time Alliance, have specifically formed to address Canada’s problems with wait times at hospitals. Overall 3 main things stand out in Canada that contribute to longer wait times:

  1. Poor coordination to transition patients out of the hospital has meant that patients stay in their hospital beds longer, which means new patients can’t get in
  2. Canadians are having a hard time finding their primary care doctors in the evenings and on weekends, so they go to the emergency room unnecessarily
  3. Electronic communication is not being used as much to check on patient’s medical history and communicate between doctors, which causes inefficiencies and gaps in care
  Canada U.S.
<1 hour in ER waiting room (2007) 38% 52%
4+ hours in ER waiting room or never seen (2007) 26% 13%
Problems with Planning Hospital Discharge 44% 28%
Difficult to Get After-Hours Care 59% 45%
ER Use in Past 2 Years 58% 49%
Specialist Lacked Medical History 29% 19%

Source: The Commonwealth Fund International Survey Data

Canada Beats U.S. At Cost of Care

Wait times are a significant issue for Canadians. The way provinces control how many doctors to train and what types has caused problems. It’s really hard to predict demand for future doctors. But this, along with other factors, are structural issues that do not have to be a part of a single-payer system. And, the fact is that Canadians are still four times as likely to visit a doctor and twice as likely to get medical treatment than a U.S. citizen because they can afford it.

Source: The Commonwealth Fund International Survey Data