in Ontario to 53.2 weeks in Nova Scotia. A 2015 Fraser Institute article focused on Canadians who sought healthcare in other countries and reported that the percentage of Canadian patients who travelled abroad to receive non-emergency medical care was 1.1% in 2014, and 0.9% in 2013, with British Columbia being the province with the highest proportion of its citizens making such trips. A 2017 Fraser Institute cost-effectiveness analysis promoted a two-tiered system with more privatization, arguing that "although Canada ranks among the most expensive universal-access health-care systems in the OECD, its performance for availability and access to resources is generally below that of the average OECD country, while its performance for use of resources and quality and clinical performance is mixed." Flaws in Canada's healthcare system Wait times In a May 28, 2020, report by the Organisation for Economic Co-operation and Development (OECD) that examined wait times in member nations—all of which are democratic countries with high-income economies with a very high Human Development Index (HDI), found that long waiting times for health services was an important policy issue in most OECD countries. In 2017, Canada ranked above the average on OECD indicators for wait-times and access to care, with average scores for quality of care and use of resources. In the 1980s and the 1990s, wait times for certain surgeries, such as knee and hip replacements, had increased. The year before the 2002 Romanow Royal Commission report was released, in 2001, the Ontario Health Coalition (OHC) called for increased provincial and federal funding for Medicare and an end to provincial funding cuts as solutions to unacceptable wait times. In December 2002, the Romanow Report recommended that "provincial and territorial governments should take immediate action to manage wait lists more effectively by implementing centralized approaches, setting standardized criteria, and providing clear information to patients on how long they can expect to wait." In response to the report, in September 2004, the federal government came to an agreement with the provinces and territories add an additional C$41 billion over a ten-year period, to the Canada Health Transfer (CHT) to improve wait times for access to essential services, a challenge that most other OECD countries shared at that time. By 2006, the federal government had invested C$5.5 billion to decrease wait times. In April 2007, Prime Minister Stephen Harper announced that all ten provinces and three territories would establish wait-time guarantees by