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Rick Anderson, a Toronto health care consultant, said that less than 1 percent of the health care deemed medically necessary by a province or territory is administered in the private sector.

“We’re not there yet, and it’s going to be a slow process,” he said. “But there is more momentum than there has been in years.”

It is difficult to accurately gauge the growth rate of the private health care industry since the Chaoulli decision because no organization in Canada tracks the number of private health care facilities. The best guess, Dr. Nagy said, is that there are now 23 private surgical centers offering medical services nationally, as well as 17 cataract clinics.

Patients must be patient

To stem the tide toward privatization, Canada will have to solve the national health care system’s Achilles’ heel: wait times to see physicians and for needed surgery.

Following a referral from a general practitioner, between 1993 and 2006, it took an average of 20 weeks in the province of New Brunswick to see a specialist, according to an ongoing study by the Fraser Institute. New Brunswick had by far the longest wait time of the provinces, with Ontario and British Columbia tying for the shortest wait time to see a specialist at seven weeks. The average for the entire country was about nine weeks.

The average wait time between a referral by a physician and an appointment with a neurosurgeon can take as long as 21 weeks, according to the Fraser Institute. Cancer patients in Canada experience the shortestwait times, generally waiting no longer than three weeks to see a doctor.

“If you’re healthy and willing to wait, it is the best system in the world,” Dr. Gratzer said. “What you discover is there are wait times in Canada for any condition.”

Colin McMillan, president of the Canadian Medical Association, attributes long wait times to a lack of capacity in the health care system. During the 1990s in a money-saving effort, the federal government drastically cut back on medical training courses and cut off foreign doctors from legally practicing in Canada.

“We thought there was a surplus of doctors at the time. We thought we could save some money,” he said. “The chief problem our health care system faces today is access due to a lack of doctors, nurses, hospitals and technology.”

Turning around the problem of long wait times will not be an easy task, according to researchers.

“We don’t have the resources to lower them despite now spending more on health care than every other country with a universal health care system outside of Ireland,” said Nadeem Esmail, director of health system performance studies and manager of the Alberta Policy Research Centreat the Fraser Institute.

However, Dr. Rachlis, a staunch supporter of public health care, contends that while the wait time issue threatens the viability of the medical system, there are methods within the system to better manage wait lists.

“The government needs to champion public wait-list reforms. Physicians must work in teams, including health care professionals and nurses, rather than on their own, and accountability for wait-list management must be transferred from individual surgeons to health authorities working with groups of surgeons,” he said.

According to Dr. Rachlis, these problems are related to a failure to move to a group medical practice and to organize modern patient-flow processes. “We’re still using the Pony Express, but expecting communication at the speed of light,” he said.

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