By Bacchus Barua and Mackenzie Moir

As we make our peace with the “new normal” and face a second wave of COVID-19, another albeit familiar challenge looms large—call it the “old normal” of Canadian health care. According to recent reports, hospitals are once again bursting at the seams with patients, staffing is stretched and “hallway health care” has turned into “parking lot health care” in some parts of Ontario. Crucially, data suggest this situation is not primarily driven by the pandemic, with only 350 COVID patients currently admitted to hospitals in Ontario.

The problem? The old normal.

The Fraser Institute’s latest comparison of international health-care systems reminds Canadians what we’ll return to when the pandemic ends. The study compares Canada’s health-care spending and performance to 28 universal health-care systems (on an age-adjusted basis in 2018). Despite being the second-highest spender (11.3 per cent as a percentage of GDP), Canada’s health-care system routinely delivered mixed to poor performance compared to our international peers.

Of specific concern, Canada has remarkably few medical resources per capita. For example, we ranked second-last for acute care beds (25 out of 26), with 2.1 beds per thousand people. BY comparison, South Korea has nearly four times as many beds available (8.1 per thousand) while Japan (5.8 per thousand) and Germany (5.5 per thousand) have almost three times as many.

Ontario’s overcrowded hospitals—again, despite few COVID-19 patients—suddenly make a lot of sense. We also rank near the bottom of the pack for the number of physicians available (26 out of 28) with only 2.8 physicians per thousand population, far behind countries such as Austria (5.2 per thousand).

Of course, Canada also performs poorly on timely access to care. For example, 30 per cent of Canadian patients reported waiting for two months or longer for an appointment with a specialist compared with only 3 per cent in Germany, 4 per cent in France and 7 per cent in the Netherlands. Similarly, 18 per cent of patients in Canada reported waiting four months or longer for elective surgery compared to Switzerland (7 per cent) and Germany (0 per cent). Clearly, even in the pre-COVID world, our health-care system struggled to address routine demand for patient care, despite ranking among the top spenders in the world.

To be fair, it’s not all bad news. Canada reports fewer patients dying after heart attack (9 out of 27) and a relatively good record for breast cancer (5 out of 26) and colon cancer survival rates (8 out of 26).

Finally, it’s important to recognize Canada’s health-care workers who have done a tremendous job seeing us through this pandemic. They deserve our immense gratitude. Furthermore, the recent challenges to hospital capacity reported in Ontario may well be at least partially due to an estimated 200,000 to 400,000 surgeries that were either postponed or delayed due to COVID. However, the findings from our latest study serve as an important reminder that we faced similar challenges in 2018, well before the pandemic.

While all countries have been affected to varying degrees by COVID-19, the “normal” they will return to will be very different from Canada’s. Though we may have to eventually learn to live with COVID, we should not have to live with unnecessary failures of our health-care system. Better health care models, which routinely deliver superior performance for comparable cost, exist and we should work towards a “better normal” once the pandemic is over.


Bacchus Barua and Mackenzie Moir are analysts at the Fraser Institute.