Re: Failing health care delivery in Canada is the result of an outdated operating model

Issue: BCMJ, vol. 68, No. 2, March 2026, Page 54 Letters
By: Paul Park, MB, BChir, MRCGP

I read Dr Tevaarwerk’s article [BCMJ 2025;67:359-364] with interest. I’m a family physician (GP from the UK, really) who moved to Canada 3 years ago. I worked in National Health Service (NHS) management and strategy for several years, and I have a PhD in epidemiology, so how different health systems work is of great interest to me. I don’t know much about the Dutch health system, but of course I know a great deal about the UK’s NHS, and I have studied other systems. I don’t think the Canadian system (or the British Columbian system, specifically) is actually that similar to the UK’s, and I don’t think “command and control” is that good of a description of the BC system, certainly not compared with the NHS. It would be more accurate to describe the NHS as a highly centralized commissioner–provider system. Canada has a much more federated system (like Germany), which works to its advantage. Yes, it’s also commissioner–provider, but that’s not command and control—it seems designed to allow more flexibility in the system to account for huge geographic and population differences. There’s very little command or control over the primary care system, which doesn’t even require family physicians to attach all patients who apply (as is required in the UK, which is why it has universal GP coverage).

I would also have thought that a major difference between the Dutch and Canadian systems is the massive geographic and population challenges, such as the fact that Canada is more than 200 times the size of the Netherlands. Providing anything resembling universal health care across such a wide area and variable population is always going to be much more expensive.

The Netherlands does indeed generally outperform Canada in health care, but it isn’t a huge difference by any means, as seen in the Mirror, Mirror 2024 report from the Commonwealth Fund.[1] For what it’s worth, Canada even slightly outperforms the Netherlands in reducing mortality and administrative barriers to care.

From what I’ve seen, the Canadian system (at least in BC) isn’t perfect by any means, but it continues to get a lot of things right and is noticeably more sustainable and robust than the one I left in the UK. I’m sure it can improve, and better integration is certainly one way it could, but I don’t think paying doctors more is particularly part of the answer.
—Paul Park, MB, BChir, MRCGP
New Westminster

This letter was submitted in response to “Failing health care delivery in Canada is the result of an outdated operating model.”

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References

1.    Blumenthal D, Gumas ED, Shah A, et al. Mirror, Mirror 2024: A portrait of the failing U.S. health system. 19 September 2024. Accessed 19 December 2025. www.commonwealthfund.org/publications/fund-reports/2024/sep/mirror-mirror-2024.

Paul Park, MB, BChir, MRCGP. Re: Failing health care delivery in Canada is the result of an outdated operating model. BCMJ, Vol. 68, No. 2, March, 2026, Page(s) 54 - Letters.


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