Lack of primary care responsible for nearly one million unnecessary ER visits across Canada, MEI finds

• Think tank recommends taking inspiration from Germany and the Netherlands to improve access to primary care providers.

Montreal, October 31, 2024—Taking inspiration from German and Dutch health systems could help improve access to primary care providers such as family doctors, according to an MEI publication released this morning.

“The lack of access to primary care providers such as family doctors is being felt in other parts of our health system, which are forced to deal with more numerous and more acute cases,” explains Krystle Wittevrongel, director of research at the MEI and co-author of the publication. “Our emergency rooms would have seen nearly one million fewer patients in a year, helping reduce wait times, if not for this lack of access to primary care.”

Among Canadians who needed access to primary care, only 26 per cent said they were able to get a same-day or next-day appointment last year.

This compares with 51 per cent and 54 per cent of German and Dutch patients, respectively, who reported being able to get a same-day or next-day appointment when necessary.

A lack of primary care access has led many Canadians to seek care in emergency rooms, or delay treatment altogether.

It is estimated that in the 2022-23 fiscal year, Canadian emergency rooms have had to field over 960,000 visits that could have been managed by primary care professionals. Those avoidable ER visits increased the cost of health care by $145 million nationwide.

The report recommends taking inspiration from aspects of the Dutch and German health systems to make better use of the time of our primary care professionals.

Among other things, it recommends getting rid of a system called “gatekeeping,” whereby patients are prevented from accessing specialists without a prior referral from a general practitioner.

The authors explain that this system increases the number of appointments that general practitioners have to field, thus diminishing their ability to care for other patients or accept new ones.

Such referrals are mandatory in Canada, but not in Germany. In the Netherlands, mechanisms exist for patients to bypass the gatekeeper system.

While this practice is often justified as a cost-saving measure, the evidence that it reduces costs, or the number of specialist visits, is unclear.

“In most cases, it seems that requiring patients to get a referral from a general practitioner doesn’t reduce the need to see a specialist, it just adds one more appointment with one more health professional,” explains Wittevrongel. “That is a very poor use of our limited primary care resources.”

The authors also recommend:

• Allowing duplicate private insurance for medically necessary services in order to encourage competition and expand patient options.
• Permitting mixed practice for healthcare professionals, allowing them to work in both the public and private sectors simultaneously, thus enhancing flexibility and increasing the number of professionals available to provide care.

“Most health interventions rely on a strong foundation of primary care; if that foundation fails, health outcomes will inevitably suffer,” says Wittevrongel. “This failure isn’t just reflected in statistics, but is visible across our communities: Canadians are enduring unnecessary hardships because they can’t access timely care, placing an even greater strain on the healthcare system.”

The MEI study is available here.

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The MEI is an independent public policy think tank with offices in Montreal, Calgary, and Ottawa. Through its publications, media appearances, and advisory services to policymakers, the MEI stimulates public policy debate and reforms based on sound economics and entrepreneurship.

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