B.C. Needs Health Care Fixes, Not Tweaks

Commentary
By Mackenzie Moir

In December, the Eby government announced the early results of its health-care “administrative review.” While the government is keen to let voters know it found some savings and put them towards frontline care, nothing about the announcement indicates much will change for patients struggling to access care.

And the access problems are dire. Last year, patients in British Columbia faced a median wait of 32.2 weeks for care, the longest wait on record. They also faced a median wait of more than three months for a CT scan and nearly six months for an MRI. With waits like these, it’s little wonder why B.C. patients are some of the most likely to leave the country and seek out treatment abroad.

And yet, despite these facts, the Eby government has yet to announce any real plans to reform the province’s health-care system.

Instead, its administrative review cut some bureaucratic fat and reportedly found $60 million in savings that could be redirected to the frontlines (incidentally, $60 million equals only about 0.15 per cent of the $40.7 billion the province spent on health care in 2025). The government is also acting on the early review findings and creating a new shared service bureaucracy to reduce redundant administration between health regions.

But all this likely won’t change how the system operates for patients or meaningfully improve access to care. In other words, the Eby government has opted to rearrange the chairs on a sinking ship.

So, how could the B.C. government help improve the province’s health-care system?

It could learn from other better-performing universal health-care systems such as Australia, Germany, the Netherlands and Switzerland, which provide timelier care and more medical resources (e.g. doctors, MRI machines, CT scanners) while spending a similar amount or less on health care than Canada.

For example, currently the B.C. government gives hospitals a lump-sum budget at the start of each year. The result? Each patient is a drain on the budget, so there’s little incentive to care for more patients or even attract more patients to the hospital.

But in all other more successful universal health-care countries, governments pay hospitals for each patient hospitals treat, based on each individual patient’s condition and complexity. This means every patient represents an additional source of revenue for the hospital rather than a drain on its budget. And hospitals have a high-powered incentive to find ways to treat more patients and attract patients.

According to studies from around the world, by paying hospitals based on their activity, governments can help increase the volume of care provided, reduce costs per admission, and most importantly for British Columbians, shorten wait times.

If the Eby government pursued hospital payment reform, it wouldn’t have to reinvent the wheel. Some of the countries that use this style of funding began their reforms in the 1990s, which means they now have multiple generations of innovations built into their hospital payment systems. The Eby government could tap into this wealth of experience abroad, and also learn valuable lessons from B.C.’s own pilot project with this payment system from 2010 to 2013, to guide any reform.

Sadly, patients in B.C. should expect very little from the Eby government’s administrative review of the province’s health-care system. They’ll also have to make peace with lengthy wait times as long as the government remains content with administrative shuffles and steers clear of sensible and time-tested reform.

Mackenzie Moir is a Senior Policy Analyst at the Fraser Institute.