Winnipeg Free Press - PRINT EDITION

Canada's costly health care wait times

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Vancouver -- Waiting has become a defining characteristic of the Canadian health care experience, but the consequences imposed on patients by delayed access to universally accessible care are too often ignored in the health care debate.

To be clear, some Canadians can wait (and wait...) with minimal consequence. Not so for others. Long delays can lead to a further deterioration in the untreated condition, meaning a more complex and difficult treatment at the end of the wait and possibly a poorer outcome. For some, long waits may condemn them to life-long disability or even death. The potentially fatal nature of waiting was not lost on the Supreme Court of Canada when it ruled against the public monopoly in health insurance in Quebec in 2005.

And there are psychological consequences to waiting. Some may develop addiction to narcotics they take while waiting. Some will contend with loneliness imposed on them by the untreated medical condition, possibly from reduced mobility but also potentially because of a risk of deeply embarrassing events such as falls or incontinence. That embarrassment may also extend to increased reliance on others, even for the basics of life such as washing. And some may end up struggling with depression, despite the temporary nature of their situation.

And, of course, there are economic consequences related to reduced productivity in the workplace, an increased need to take time off and possibly impacts on family income.

What can governments in Canada say to Canadians whose lives have been harmed (if not destroyed) by long wait times for medically necessary care? They cannot, with any honesty, tell them the wait time was unavoidable in a universal access health care system. Nor can they honestly say they are on the path to meaningfully and permanently shortening wait times for those stricken with illness.

The latest evidence on efforts to reduce wait times across Canada suggests failure: Spend-and-manage approaches simply don't work in reducing delay. Efforts that fail to deal with the underlying policies that created waiting lists in the first place will only leave provinces facing a larger bill for the same delays.

So what does work? The evidence from Europe suggests fostering competition, where compensation follows patients, is a key approach to reductions in waiting. Broadly defined wait time targets, with clear and serious consequences for those who fail to meet them, also seem to work well. And, if the experiences of Belgium, France, Germany, Japan, Luxembourg, the Netherlands, and Switzerland are to be believed, a larger role for the private sector in financing and delivery can lead to universal access health care without queues for treatment.

All this flies in the face of what we're constantly told about waiting and health care in Canada.

We're told a public monopoly is the most efficient approach to universality, yet these other nations spend less and get more timely care with a private parallel system.

We're told public provision and management are the keys to solving the wait times problem, yet these other nations have improved timeliness (and, in the case of the Netherlands, got rid of wait times problems) by embracing competition and activity-based funding.

We're told public hospitals are the only way to have a good universal system, yet these other nations have more accessible and less expensive systems with the inclusion of private hospitals.

We're told the answer can only be found in the "public" system, yet we know that competition, with money following the patient to the facility of their choice (private or public), means shorter wait times and more patient-focused care.

Long wait times are causing Canadians significant harm. The solution is to step away from the wrong-headed, ideologically guided approach governments are taking today. Policy-makers should instead focus on how other, more successful, universal-access nations have improved the timeliness of health care for their citizens. Our health care problems aren't unique or different from anyone else's, and it's time we took a more pragmatic approach to reform with policies that actually work.


Robert Ouellet is past president of the Canadian Medical Association and a Fraser Institute senior fellow. Nadeem Esmail is director of health policy studies at the Fraser Institute.


Republished from the Winnipeg Free Press print edition November 26, 2013 A9

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