Universal health care shouldn’t mean universal waiting

OTTAWA—Recently, my wife badly injured her foot while hiking. The pain became excruciating and she could not put any weight on it, so we went to the emergency department.

What followed was painfully familiar: hours in a waiting room, exhaustion, no sleep, and no real sense of when she would be seen. The night stretched into morning.

I found myself thinking what I have thought after virtually every emergency-room visit of my adult life: unless I am convinced I absolutely need to be there, I would rather avoid the hospital altogether.

That should alarm us.

A health-care system is failing at accessibility when people delay or avoid seeking care because they know it can mean spending eight, 12 or even 17 hours exhausted, uncomfortable and uncertain in a hospital waiting room.

According to the Canadian Institute for Health Information, Canada recorded 16.1 million emergency-department visits in 2024–25. Another 1.2 million visits, 7.7 per cent, ended with patients leaving before they had even been seen and assessed by a physician. At large urban hospitals, one in 10 patients spent more than 17.4 hours in emergency.

Canada can do better. But the answer is not simply “hire more doctors.”

The Canadian Association of Emergency Physicians identifies “access block” as the primary driver of emergency overcrowding: admitted patients remain in emergency because an inpatient bed or appropriate downstream care is unavailable.

The blockage travels backward.

A patient medically ready to leave hospital may be unable to do so because home care, rehabilitation, or long-term care is unavailable. The bed remains occupied. The next patient cannot leave emergency. Another patient remains in the waiting room.

Emergency care, therefore, has to be treated as one continuous system, not merely a waiting-room problem.

The sickest patients must always receive priority. But “sickest first” does not have to mean “everyone else waits indefinitely.”

Hospitals should operate parallel care streams: resuscitation for life-threatening emergencies, acute care for complex cases, and rapid-care pathways for stable conditions that can often be resolved relatively quickly.

Emergency physicians themselves recommend approaches such as rapid-assessment and fast-track zones, medical directives and staffing aligned with patient-arrival patterns.

Where clinically safe, testing should begin at triage.

Consider someone arriving with a suspected broken ankle. Why must the process always be triage, wait for hours, doctor, X-ray order, wait again, X-ray, wait again, doctor?

With appropriate medical directives, some patients could proceed to imaging earlier so the results are ready when the clinician sees them.

Then modernize the waiting itself.

Once a qualified professional has triaged a patient and determined that they are stable and do not require continuous observation, why must they physically occupy a waiting-room chair for another six, eight, 12 or more hours?

Register their cellphone number. Text them updates. Let them go home, rest, elevate an injured limb or simply sleep. Notify them when their care window is approaching and require them to return within a specified period.

Patients who require monitoring would remain. But for those who do not, waiting for care should not mean sitting in a hospital for untold hours simply to preserve their place in line.

If a smoothie shop can text me when my order is ready, surely a modern hospital can tell a medically stable patient when it needs them back in the building.

This is not science fiction. A 2026 Canadian study of a digital self-triage and scheduling pathway for selected lower-acuity patients found shorter waits and emergency-department stays, fewer return visits and high patient satisfaction.

Technology, however, cannot fix a hospital that is permanently full.

Canada also needs sufficient acute-care capacity, real-time bed management, the ability to safely discharge patients seven days a week, and greater capacity in home care, rehabilitation, transitional care and long-term care.

Home care, long-term care and rehabilitation are all part of emergency-department capacity because when those services are unavailable, patients remain in hospital beds that others urgently need.

Canada should also make emergency care more seamless across provincial borders. Living in the National Capital Region makes the problem particularly obvious: Ottawa and Gatineau form one metropolitan region, yet patients navigate two provincial health-care systems.

Present a valid provincial health card. Receive medically necessary emergency care anywhere in Canada. Let governments settle the bill behind the scenes. Essential medical information should follow patients, too.

Finally, governments should publish standardized performance measures, including total time spent in emergency, admission-to-bed delays, ambulance offload times and the percentage of patients who leave before receiving care.

And publish the 90th percentile, showing how long 90 per cent of patients waited or stayed, not just the average.

Canadians deserve to know what happens when the system fails the person near the back of the queue.

These ideas form part of a broader Canadian Emergency Care Modernization Plan I have developed, focused on improving patient flow from triage through discharge, modernizing waiting, reducing access block and making care more seamless across provincial borders.

None of this requires abandoning universal health care.

We can support universal health care while refusing to accept dysfunction as an inherent feature of it.

The technology exists. The operational science exists. The clinical expertise exists. Many pieces of the solution are already being used somewhere in Canada.

The consequences of delay are not merely frustrating. The Canadian Association of Emergency Physicians warns that overcrowding is associated with delayed diagnosis and treatment and increased mortality.

A health-care system should not make people sicker while they wait to receive care. Nor should it train people to avoid seeking care because they dread the ordeal of accessing it.

Universal health care shouldn’t mean universal waiting.

It should mean universal access to care that is timely, connected, efficient and humane.