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Waiting lists are a major problem under the

care system is an enormous part of the

Canadian system. No accurate government

Canadian welfare state. On the provincial

data exists, but provincial reports do show at

level, the health care system amounts to

least moderate waiting lists. The best informa-

between one-third and one-half of all social

welfare spending.313

tion may come from a survey of Canadian

physicians by the Fraser Institute, which sug-

Provinces must provide certain benefits,

gests that as many as 800,000 Canadians are

including primary care doctors, specialists,

waiting for treatment at any given time.

hospitals, and dental surgery. Other benefits,

According to this survey, treatment time from

such as routine dental care, physiotherapy,

initial referral by a GP through consultation

and prescription drugs, are optional. Some

with a specialist, to final treatment, across all

provinces offer substantial coverage for these

specialties and all procedures (emergency,

services, some cover them only partially, and

nonurgent, and elective), averaged 17.7 weeks

some do not cover them at all. Except for

in 2005.315 And that doesn't include waiting to

emergencies, treatment by specialists or hos-

pital admission requires a referral from a pri-

see the GP in the first place.

mary care physician.

Defenders of national health care have

Provider reimbursement is set by each

attempted to discount these waiting lists, sug-

U.S. patients are

province, and some provinces restrict overall

gesting that the waits are shorter than com-

actually more

physician income. In general, however, reim-

monly portrayed or that most of those on the

bursement is on a fee-for-service basis. Hospi-

waiting list are seeking elective surgery. A look

likely than

tals are paid a specific pre-set amount to cover

at specialties with especially long waits shows

Canadians to

all noncapital costs. Capital expenditures must

that the longest waits are for procedures such

receive preventive

be approved on a case-by-case basis.

as hip or knee replacement and cataract

An increasing number of Canadians also

surgery, which could arguably be considered

care for chronic

carry private insurance, most often provided

elective. However, fields that could have signif-

or serious health

through their employer. Originally this

icant impact on a patient's health, such as neu-

insurance was designed to cover those few

rosurgery, also have significant waiting

conditions.

times.316 In such cases, the delays could be life

services not covered by the national health

care system. At one time, all provinces pro-

threatening. A study in the Canadian Medical

hibited private insurance from covering any

Association Journal found that at least 50

service or procedure provided under the gov-

patients in Ontario alone have died while on

the waiting list for cardiac catheterization.317

ernment program. But in 2005, the Canadian

Supreme Court struck down Quebec's prohi-

Data from the Joint Canada­United States

bition on private insurance contracting.314

Survey of Health (a project of Statistics Canada

and the National Center for Health Statistics)

Litigation to permit private contracting is

revealed  that  "thirty-three  percent  of

now pending in several other provinces.

Canadians who say they have an unmet med-

In addition to the public hospitals cov-

ical need reported being in pain that limits

ered by the government, many private clinics

their daily activities."318 In a 2005 decision

now operate, offering specialized services.

Although private clinics are legally barred

striking down part of Quebec's universal care

from providing services covered by the

law, Canadian Supreme Court Chief Justice

Canada Health Act, many do offer such ser-

Beverly McLachlin wrote that it was undisput-

vices in a black market. The biggest advan-

ed that many Canadians waiting for treatment

tage of private clinics is that they typically

suffer chronic pain and that "patients die while

on the waiting list."319

offer services with reduced wait times com-

pared to the public health care system.

Clearly there is limited access to modern

Obtaining an MRI scan in a hospital could

medical technology in Canada. The United

require a wait of months, whereas it could be

States has five times as many MRI units per

obtained much faster in a private clinic.

million people and three times as many CT

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