In 2007, waiting times for access to health care in Canada reached a new historical high: 18.3 weeks averaged across 12 medical specialties. While many politicians are likely to respond by pointing to costly government programs and initiatives attempting to shorten wait times, few will ask the important question: why are Canadians waiting at all?
Wait lists for medically necessary health care are Canada’s shame. Canadians are generally proud of their universal access health insurance program, which ostensibly provides access to care regardless of ability to pay. But, as Chief Justice of the Supreme Court Beverley McLachlin and Justice of the Supreme Court John Major stated: “Access to a waiting list is not access to health care.”
An examination of Canada’s lengthy wait lists can help put that statement in perspective. For example, Canadians waited some 25 weeks for cataract surgery in 2007 from the time their general practitioner (GP) referred them to a specialist to the time they received treatment. More alarmingly, Canadians waited some 42 weeks for joint replacement from GP referral to treatment. This means that of those patients who were referred by their GP for a hip or knee replacement surgery on January 2, half will receive their treatment by October 21 while half will still be waiting for care.
Consider for a moment the personal costs a wait time of that magnitude entails. Of course there are the medical issues of an adverse event while waiting, a potentially worse outcome from surgery, or a potentially more difficult surgery/recovery as a result of deterioration over the 42 week period. But there are also additional and often significant personal costs that are rarely accounted for in Canada.
Any wait time, even a short one, entails some amount of pain and suffering, mental anguish, lost productivity at work and leisure, and strained personal relationships. Wait times can also take a toll on the family and friends of those waiting, and may even have an effect on an individuals’ ability to provide for themselves and their loved ones.
How concerned are governments about the personal costs associated with these lengthy wait times? Not much it seems. While they are focusing on defining a limit to how long Canadians should wait for care, their focus is from the perspective of avoiding serious negative health consequences and not from the perspective of minimizing waiting (and thus personal costs) altogether.
According to the Pan-Canadian Benchmark Wait Times announced jointly by the federal, provincial, and territorial governments in December 2005, being treated within 26 weeks from the time a Canadian sees a specialist to the time they receive treatment for hip or knee replacement surgery is reasonable. So is being treated within 26 weeks for level 3 cardiac bypass surgery, or 16 weeks for cataract surgery for patients at “high risk,” or 4 weeks for radiation therapy. Notably, many of the provincial wait times guarantees announced earlier this year are much longer than even these generous targets.
For those wondering how we can get ourselves out of this mess, the answer is surprisingly simple. Canadians must move beyond the politics and rhetoric that plague the health care debate and let health care policy reform be guided by a serious examination of the policies of the nations that deliver universal access health insurance without waiting lists.
Austria, Belgium, France, Germany, Japan, Luxembourg, and Switzerland provide what many Canadians might see as the impossible dream. In each of these nations, individuals are guaranteed access to health insurance regardless of their ability to pay. And each of those individuals, regardless of their income or wealth, has access to the health care they need without waiting lists. Equally importantly, the cost of these health care systems is, on an age-adjusted basis, similar to or less than Canada’s, so Canadians need not dig deeper into their pockets to achieve this sort of access.
In these nations, patients are free to choose for themselves whether their care provider will be a public or private hospital, all under the terms of the public insurance contract. They must, however, share in the cost of the care they consume, which encourages them to make more informed decisions about when and where it is best to access the health care system. Patients in these nations are also free to purchase the care they desire privately if they wish to do so.
While patients in these seven nations bear more personal financial responsibility for the care they consume, they also enjoy more freedom in determining who will pay for and who will deliver the care they need. The result is that patients enjoy access to care without waiting lists.
Each of these sensible policies has come under fire in Canada as a road to the “Americanization” of health care. But the experiences of those seven nations shows that these polices will do nothing of the sort. Instead, they will provide all Canadians with wait-list free access to a world-class health care program regardless of ability to pay; a significant departure from the system we have today.