"Acceptable" Wait Times?

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posted April 7, 2005

A group of Canadian physician associations (the Wait Time Alliance) has just released a report on providing Canadian patients more timely access to care. Surprisingly, the report shows little regard for the pain and suffering patients experience while waiting for medical treatment. Even more troubling than the report itself is that this lack of regard for patients’ needs is becoming remarkably popular in Canada.

All current and proposed provincial and federal wait time initiatives are pursuing a strategy similar to that proposed by the Wait Time Alliance. In every case, the goal is to prioritize the current waiting lists, determine what a medically acceptable or maximum allowable wait time is, and then work towards ensuring that Canadians wait no longer than those ‘acceptable’ wait times. The key assumption being that patients will always be waiting for treatment in Canada.

Of course, it is perfectly acceptable to have some lag between the time a patient’s need is identified and when they get treatment, just as we experience some waits to see our dentist or our car mechanic. But those latter waits are driven by scheduling issues. And the services in both cases are ultimately delivered within a few days of when we desire them. We don’t wait for long because the service providers have adequate capacity to respond to our needs.

By contrast, the ‘acceptable’ waits being proposed in Canada are acceptable only from the perspective of involving “acceptable” negative health consequences of waiting for care in the opinion of those detached worthies doing the assessment. You will not die nor will your condition deteriorate significantly. However, no account is taken of the personal costs (mental anguish, pain and suffering, reduced productivity at work, additional stress on personal relationships, etc.) that accompany any wait for care.

Part of the problem here is that we have given in to the problem before we start. There is no thought given to the possibility that the only acceptable wait is no wait. The Health Council of Canada points out that it would be ’inefficient’ to have all those medical resources just waiting around for people to get sick…unthinkable. Or is it?

While the idea of receiving treatment in such a time frame may seem the impossible dream to some Canadians, such on-demand treatment is already being delivered elsewhere in the developed world. Patients in Austria, Belgium, France, Germany, Japan, Luxembourg, and Switzerland enjoy access to health care (regardless of ability to pay) with only short waits for treatment – like the scheduling waits we are familiar with for the other services we need.. Further, the cost of these health care programs is, on an age-adjusted basis, less than the cost of Canada’s Medicare program, so achieving similar success in Canada does not require increasing this nation’s already high level of health spending.

Their remarkable performance, one that benefits both patients and the payers who fund their care, is made possible through the use of competition and proper incentives. As a result of these policies, patients are led to make more informed decisions when seeking care while providers are encouraged to deliver more health services at higher quality and more efficiently than they would otherwise.

And therein lies the ultimate solution to the problem of long waits for treatment in Canada. The policies pursued in these nations: cost sharing for medical services, private competitive provision of publicly funded care, and the availability of private care for those who cannot receive appropriate care from the public program, would give Canadians a superior health care program. A program that is patient-focused and that delivers what patients desire: excellent access to the very best health care that is available.

While the Wait Time Alliance and all provincial and national wait list initiatives should be applauded for recognizing that there is a problem and actually trying to do something about it, they fall well short of serving patients’ legitimate needs. These programs are all built on the premise that Canadians must wait for care and will always wait for care.

International evidence and experience suggests that such a fundamental belief is flawed: it is possible to give patients excellent access, on their own terms, to a responsive, efficient, and high quality health care program. But doing so will require an informed and honest debate about what works, rather than a blind commitment to managing what doesn’t.

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