Two new reports paint a grim picture of Canada’s health-care system.
One report, from the Fraser Institute think tank, found Canada ranked third in health-care spending among 31 countries with universal health care.
Despite this largesse, we ranked near the bottom for number of doctors, hospital beds, MRI machines and CT scanners. Unsurprisingly, we therefore also ranked last or close to last for wait times.
Ouch.
The second report, from the Second Street think tank, was less orthodox. It ranked 83 major Canadian hospitals based on an analysis of patients’ Google reviews. None received the top rating of five stars. Just one received a four-star ranking (B.C.’s Mount Saint Joseph Hospital, if you’re curious). The average hospital rating was 2.91 out of five.
On first blush, this might not seem so bad. Until you think about your personal use of online reviews. Something in the 4.5 to 5-star range is an easy “yes,” right?; 3.0 to 4.5, you’re likely to explore other options; below 3.0? A red flag.
Second Street’s report makes this point. The hospital average of 2.91 is “a score that, if attached to a restaurant or garage, would dissuade many customers from a dining experience or trusting a mechanic to fix their car.”
Indeed.
Now, before you object, we’ll say it ourselves: patient reviews are an admittedly imperfect proxy for gauging hospital performance. Patients are not necessarily well-positioned to understand how well a hospital is functioning, just as they are not especially well-suited to evaluating the treatment they receive from a doctor.
Patients may also be more likely to complain about negative experiences than to speak up about positive ones. And it may not occur to many that it’s even possible to leave a Google review for a hospital.
But these objections all point to one of the problems with our approach to health care: We don’t think about patients as responsible for holding the system to account, as a customer might.
While health care is clearly in a different category than, say, your cell phone provider, the system would benefit from patients demanding more accountability.
After all, we fund the system. The average Canadian family paid $19,000 in taxes toward health care in 2025, a separate report by the Fraser Institute says. For Canadian families in the top ten per cent of earners, it’s $59,000.
If patients brought more of a customer service mentality to health care, we might get more exercised about having to wait — as a majority of Canadians do — more than a month to see a specialist and more than two months to receive non-urgent surgery. Contrast the lack of outrage over these waittimes to the national fury over the Rogers service outage in 2022.
Canadians need to demand better, and doctors and politicians need to deliver better.
At present, we have a system that largely lacks accountability. This was a key takeaway from our interview last fall with Dr. Hugh Scully, a cardiac surgeon and past president of both the Canadian Medical Association and Ontario Medical Association.
Scully’s words are worth reproducing at some length here:
“What is missing in the system is accountability,” he said. “The provinces expect a certain amount of funding from the government. But there is still not a dependable way of accounting for how those funds are spent.
“If we [can introduce accountability], I am confident we can do a lot more with public funding than we’re able to do at the present time.”
Scully shared how he and a team of experts introduced accountability for cardiac surgeons in Ontario in the 1980s and ‘90s — reforms that still remain in place today.
Their team tasked officers in hospitals with evaluating physicians’ wait times, surgery results, operating times, patient recovery times and complications. They created annual reports and incentives for each surgeon and cardiologist.
“What happened over a course of years is we eliminated the waiting lists,” Scully said. “Over 10 years, we saved $1 billion that could be used for other areas in health care …
“And at the end of the day, the patients were the beneficiaries.”
We’re no doctors, but this certainly sounds reasonable — and worth trying.
At a time when governments across the country are talking about the need for austerity measures, it could be the perfect moment to prioritize reforms that demand better outcomes for the same amount of money.
Other countries have shown it can be done. Dr. Scully has shown it can be done. It’s well past time for us to do it.
