Another reminder that Canada’s health-care system is failing patients

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Appeared in the New Brunswick Telegraph-Journal, April 11, 2016

Shorter waits for hip-fracture repair, and eight out of 10 Canadians receiving “priority procedures” within government-defined benchmarks.

Sounds pretty good, right?

However, these highlights from the Canadian Institute of Healthcare Information’s (CIHI) annual update of Wait Times for Priority Procedures in Canada are little more than feel-good distractions from the real story: Canada’s health-care system is failing to deliver timely care to patients.

This failure is partially recognized in the CIHI report itself. By simply viewing the data from another angle we note that, overall, two out of 10 Canadians do not receive “priority procedures” within the remarkably long benchmarks used in the report (six months for hip and knee replacements, for example). Moreover, governments still do not generally report comprehensive and comparable information on wait times for most medically necessary procedures.

More detailed statistics from other sources paint an even grimmer picture. For example, the Fraser Institute’s most recent wait times report finds that wait times (GP to treatment) have almost doubled since 1993. Worse, physicians report that patients generally wait almost three weeks longer than what they consider clinically reasonable (after consultation with a specialist).

Many health-care officials routinely respond to such reports with talk of how these access failures can be overcome by “finding efficiencies” within the system. There is some truth to this, given evidence of hospital beds being occupied by patients with nowhere to be discharged to, operating rooms being underutilized, and the lack of a central registry to pool referrals in most provinces. However, the overarching issue is that the predominance of government in the funding and delivery health care ensures the supply of health care is unable to meet the demand for it, and our stubborn refusal to learn from other universal health-care systems prevents us from correcting this imbalance.

On the supply side, the public system cannot be reasonably expected to expand capacity by spending more money since provincial governments already devote about 40 per cent of their budgets to health care. At the same time, private options (which may act as a pressure valve and also stimulate competition) are few and far between, are generally unavailable to the majority of the population, and are usually discouraged by government policy. This means that when the public system is saturated, patients must either endure lengthy waits or leave Canada to receive treatment. In a departure from the norm, Saskatchewan is one of the few provinces that has recently recognized how third-party private clinics can complement public resources and reduce wait times.

Meanwhile, on the demand side, individuals face few incentives to use services responsibly. Notably, and unlike most other universal health-care systems in the world, cost-sharing is effectively prohibited in Canada by federal regulations that govern transfer payments to the provinces. In the absence of any cost-sharing incentives (however small), it’s inevitable that our health-care system will be overused and potentially abused.

While there are certainly many improvements to be pursued through encouraging competition among insurers and providers, as well as correctly incentivizing hospitals through activity-based funding, it’s essentially the combined effect of limited options to expand supply, and unlimited and un-tempered demand for scarce health-care resources, that has resulted in the rationing of health care in Canada through waiting lists. Other successful universal health-care countries know these pitfalls well, which is why they have instead chosen to generally involve the private sector (as a partner, or an alternative) and expect some level of cost-sharing from patients (with exemptions for vulnerable groups, and annual caps for the general population).

Those who still stubbornly opine against the introduction of such policies should ask themselves what options they leave on the table for patients unable to receive treatment in a timely manner within the confines of our government’s monopoly on health care.

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