Hunter Prize: What Canada can learn from the EU on how to reduce surgical wait times

The Hub’s first annual Hunter Prize for Public Policy, generously supported by the Hunter Family Foundation, focused on solving the problem of long wait times in Canada’s health-care system. A diverse group of ten finalists have been chosen from nearly 200 entries, with the finalists and winners chosen by an esteemed panel of judges, including Robert Asselin, Dr. Adam Kassam, Amanda Lang, Karen Restoule, and Trevor Tombe. The Hub is pleased to run essays from each finalist this week that lay out their plans to help solve this persistent policy problem. The winners of the first-ever Hunter Prize for Public Policy will be announced on Friday, September 29.

Imagine waiting years in agonizing pain, unable to even go for a walk to enjoy some sunshine, because of a bad knee or hip. You’re reliant on painkillers, you can’t spend quality time with your friends and family, and even getting out of bed can be a struggle.

Sadly, many Canadians don’t have to imagine this. It’s a reality. Surgical wait times in our country have been on the rise for years, and it’s time for governments to take action to fix it. 

A policy from the European Union (EU), called the Cross-Border Directive, could help Canadian patients break away from this sentence of pain and suffering.

Since 2011, EU patients have had the right to travel to another EU country for surgery, pay for it, and then be reimbursed by their home country. Reimbursements cover up to the same amount the home country would have paid for treatment locally. For example, imagine a patient facing a six-month wait for knee surgery in France, who discovers the waitlist is much more manageable in Spain. This patient can take a short drive or train ride, get their operation, pay for it, and come home. From there, the French government would reimburse them with taxpayer dollars and they can go on living without chronic pain or mobility problems.

There are a few important things to note. For one, this policy is essentially cost-neutral in the medium term—they’re merely shifting when the surgery occurs, not how many.

It’s obvious that this program benefits those who travel for surgery, but it also benefits everyone else. When someone takes advantage of this program, everyone behind them on the waitlist moves up a spot.

It’s easy to see how this policy could help Canadians. 

Consider the story of Walid Waitkus. The B.C. man was just 13 years old when he was diagnosed with a rare spinal condition in 2009. At the time, his doctor insisted that he needed surgery immediately. Sadly, the government-run system took 27 months to get around to scheduling a date for his procedure. His family gave up and traveled to the U.S. to pay for care.

By then, it was too late for him. To this day, Waitkus is paralyzed from the waist down.

If traveling for care was accommodated by the B.C. government, perhaps Waitkus could have gotten his surgery in a timely manner and he could still have his mobility today.

While not everyone is affected this dramatically, Waitjus is far from alone when it comes to long waits in the Canadian health-care system.

Data acquired by SecondStreet.org shows that roughly 4.7 million Canadians are on waitlists for surgery, a diagnostic scan, or to see a specialist.

Those patients are waiting longer than ever for care. Research from The Fraser Institute shows that the average surgical time in 2022 was 27.4 weeks, up from only 9.3 weeks when the group began researching wait times in 1993. 

In 2022, over 14,000 patients died on a waitlist. Most of those cases are Canadians waiting for a procedure that would improve their quality of life—like a knee replacement. This doesn’t mean they should be discounted—would you want to spend the final years of your life in chronic pain? There are also cases where patients die waiting for life-saving surgeries, like cardiac operations.

For the sake of patients, Canada desperately needs to implement health reform. It’s not fair that governments demand a monopoly on health care and then do such a poor job of providing an essential service.

SecondStreet.org has been advancing the EU policy as an option that could help reduce wait times in Canada for well over a year. Fortunately, Alberta’s government is considering the option.

Alberta Premier Danielle Smith said on her radio show in early July that she’s seriously considering adopting something similar to the EU model for Alberta.

It’s great to see that Smith seems committed to reducing her province’s surgical waitlists. The Cross-Border Directive can make a measurable difference if the Alberta government actually implements the policy.

However, this is just talk. Smith can’t just snap her fingers and immediately have patients jetting off to Europe or California for surgery. If she decides to follow through, she’ll need a plan.

The most politically feasible way would be to implement the directive step-by-step. Identify the most urgent procedures with the longest waitlists and begin with those. Say there’s currently a long wait for knee replacements—allow cross-border reimbursement, watch the waitlist shrink, and use the pilot program to iron out any kinks when it comes to financing, dealing with surgical standards in other jurisdictions, etc. This pilot could also start with a short list of destinations, perhaps just the U.S. and other Canadian provinces, where it’s known that surgical standards are high.

From there, it can be expanded to every procedure and other parts of the world.

It’s also worth noting that copying this European policy is looked at extremely favourably by Canadians. A 2022 Leger poll, commissioned by SecondStreet.org, showed that 72 percent of Canadians (and 71 percent of Albertans) were in favour of the Cross-Border Directive. While any government attempting to implement such a change will likely face opposition from unions and activists, the public is clearly on board.

Alberta is one of the provinces most open to health reform, and it could serve as a positive example if the Cross-Border Directive is brought in. Perhaps its neighbours in Saskatchewan and B.C. would take notice of the shorter waitlists and follow its example. From there, the rest of the country could be inspired by the Western provinces, leading to a positive change for patients across Canada.

Whether that will happen remains to be seen. 

The Cross-Border Directive is not a silver bullet that will solve all of Canada’s health-care woes. Much more will need to be done to get Canada’s health-care wait times to an acceptable level.

However, it’s obvious that reforms like this are needed. Just think of the thousands of Canadians dealing with crippling pain, lost mobility, and even dead relatives due to long health-care waits. 

So, let’s think outside of the box and start allowing patients to get accessible care outside of the borders.