Why British Columbia’s Primary Care Strategy Is Failing
And What We Can Learn from Canada and the World
British Columbia’s primary care system is in serious trouble. Despite optimistic messaging from Premier David Eby and his agreement with the BC Greens, the government’s strategy emphasizes political compromise rather than structural reform.
Although recent policy announcements promote “team-based care” and “community health centres,” the situation on the ground tells a different story: patients continue to face barriers to care, emergency departments remain overwhelmed, and healthcare providers are burning out
A Mismatch Between Claims and Reality
Since 2018, the government has pointed to:
90+ Primary Care Networks
41 Urgent and Primary Care Centres
15 Community Health Centres
675,000 patients “attached” to providers
However, these investments have not delivered the expected improvements:
15% of emergency department visits in Canada involve cases that should have been treated in primary care; 9% could have been addressed virtually.
BC’s average wait time for treatment now exceeds 29 weeks—the longest on record and nearly triple what it was in 1993.
In 2023, only 22% of British Columbians received elective surgeries within two months. In contrast, the rates were 72% in Switzerland, 66% in Germany, and 58% in Australia, according to OECD and CIHI data.
Ontario has made progress by investing in surgical capacity; BC has not adopted similar measures.
Systemic Design Problems: Funding and Incentives
BC funds hospitals using fixed budgets that are not tied to patient volume or service quality. As a result:
Hospitals lack financial incentives to treat more patients.
When demand rises, service delivery does not.
Swiss hospitals conducted 15,057 discharges per 100,000 people in 2022—nearly twice BC’s estimated rate.
Canada’s emergency room visit rate is 37 per 100 people; Switzerland’s is 21.
One in ten BC patients is readmitted within 30 days, indicating ineffective or incomplete care.
Australia integrates private providers into its public system, enabling more than 300,000 episodes of public care to be delivered in private hospitals each year. These alternative models achieve better outcomes and higher efficiency.
International Comparisons: Evidence From Better Systems
Other countries demonstrate what better design can achieve:
Preventable mortality: 94 per 100,000 in Switzerland vs. 137 in Canada
Treatable mortality: 38 in Switzerland vs. 58 in Canada
Life expectancy: 83.9 years in Switzerland vs. 81.6 in Canada
Patient satisfaction: 94% in Switzerland vs. 56% in Canada
These results stem from policy choices, not just funding. Switzerland uses non-profit insurers and allows patients to choose their provider. Australia contracts with private hospitals to shorten wait times. Quebec is transitioning to activity-based funding, paying providers for services delivered.
The Human Cost: Providers Under Pressure
Design flaws don’t just affect patients—they impact providers as well:
In 2024, a breach at Interior Health compromised personal data for 28,000 healthcare workers, including Social Insurance Numbers.
Over 1,100 assaults on clinicians were reported in the past year.
Nearly half of BC’s primary care providers report weekly verbal abuse.
More than 60% of family physicians show signs of burnout, with growing numbers planning to leave the profession.
A system that fails its workforce cannot deliver sustainable, quality care.
A Policy Review Without Substance
The government’s current “primary care review” emerged from political negotiations, not system needs:
The review includes $15 million for expanding CHCs but does not address core design flaws.
There are no commitments to benchmarking against OECD indicators or reporting progress publicly.
Completion is expected in late 2025—far too late for a system already stretched thin.
What BC Must Do Now
Drawing on my previous publications about health system performance and public accountability, here are immediate actions the province must take:
Implement activity-based funding: hospitals must be paid for services provided.
Contract private clinics to expand capacity.
Empower patients with choice and transparent performance data.
Stop announcing reforms without backing them with measurable outcomes.
Launch a Public Health Performance Dashboard to report on surgical wait times, ER reliance, mortality, and satisfaction—broken down by region.
The Accountability Gap
The recurring problem is a refusal to measure outcomes and adjust accordingly.
Canada’s preventable mortality is 46% higher than Switzerland’s.
Swiss hospitals treat more patients and have lower readmission rates.
Patient satisfaction is significantly higher abroad.
BC’s current funding model prioritizes presence over performance.
These are not abstract differences—they represent lives lost, care delayed, and opportunities missed.
Premier Eby’s legacy will not be defined by how many clinics are opened, but by whether patients can access timely, effective care.
BC’s system spends more, delivers less, and avoids transparency. Switzerland, by contrast, ranks first in avoidable mortality and second in life expectancy—because it tracks, evaluates, and improves.
If BC refuses to measure real outcomes and reward real results, then meaningful reform is impossible. And public trust will continue to erode and care outcomes for British Columbians will continue to decline.