It’s no secret that if you need surgery in Canada, you better be prepared to wait a long time.
Is the problem a shortage of doctors and nurses? Underfunding? Administrative inefficiency? The blame has been placed on virtually everything and everyone over the years. Despite decades of attempts at reform, long wait times continue to be a problem across the country.
Long wait lists, hallway medicine and emergency room closures are a reality for most Canadians trying to access health care. Whatever the cause, we know the result: lost income, chronic pain and, in some cases, preventable patient deaths.
Canada is not alone in struggling with such problems. Some European countries have also had to deal with long wait times. The difference is that they were able to solve the problem. Part of their solution came from something called the “cross-border directive.”
This policy allows European patients to seek treatment in any European Union member country and obtain reimbursement of their medical costs at a level equivalent to what their national health insurance plan would have covered.
Like most policy innovations, this directive was born out of necessity. In the early 2000s, many British citizens found themselves struggling with long waiting lists for healthcare.
Yvonne Watts, one of those citizens, suffered from arthritis in her hips. Unable to get timely treatment in the UK, she applied in 2006 to have her hip replacement covered in another EU country. She was refused.
Deciding to take the matter in hand, Mr.me Watts had the operation in France at his own expense, paying the equivalent of $10,673 in today’s Canadian dollars. Mme Watts was never reimbursed for the cost of her operation, but it paved the way for the European Union’s Cross-Border Healthcare Directive.
Today, patients in a situation like his can decide to have non-urgent surgery in another country, when national waiting times are too long. Thanks to the Cross-Border Directive, more than 450,000 European patients were able to receive treatment in another European country in 2022.
In addition to reducing waiting times, the implementation of this policy has had another remarkable effect: it helps reduce the cost of illnesses, both for the patients who suffer from them and for the State which pays the bill for treatment.
In fact, the longer you wait to address a health problem, the more expensive the treatment will be, due to an increased risk of complications. The longer it takes, the more likely it is that the intervention will have to be more invasive (and therefore riskier) and that it will require more resources.
But the impact on spending is not the only thing to consider. Health issues can also have a negative impact on government revenue.
Although “elective” treatments are not considered “urgent,” the ailments they hope to treat can still impact our lives. For example, some of those languishing on waiting lists are unable to work or have to reduce their workload because of the pain they experience. Some are even eligible for workers’ compensation.
Even just looking at the income aspect, it is in the government’s interest to ensure that these workers get the treatment they need so that they can start paying taxes again. Letting them get the medical care they need out of province or out of country—at the same price that the system would pay in country—should be a no-brainer.
Let’s not forget how many Canadians cannot get the treatment they need within the recommended time frame.
In 2019, 30% of patients needing a knee implant were unable to receive it within the recommended 26-week time frame. By 2023, this figure had risen to 41%. Similarly, the proportion of patients needing hip replacements who were unable to obtain them within the legally prescribed time frame increased from 25% to 34% over the same period.
Public coverage of cross-border care would help bring these numbers closer to zero and address the significant surgical backlog. This would allow Canada to better meet the needs of patients and have more efficient health systems.