Canada’s health-care wait times costing patients many millions in lost time, wages

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Appeared in the Waterloo Region Record, June 2, 2017

For more than two decades, the Fraser Institute has annually surveyed specialist physicians across Canada to estimate how long patients wait for treatment. Our latest survey found that in 2016, overall, patients were waiting 20 weeks between referral from a family doctor to treatment—the longest wait in our survey’s history and 115 per cent longer than in 1993.

While the intervening years have seen increased measurement and acknowledgment of wait times in Canada, they also produced an unhealthy acceptance of the problem—as though wait times are the necessary price for universal health care. Like the anecdote of the frog in the pot of cold water, which is slowly brought to a boil without the frog’s knowledge or immediate discomfort, the slow but fairly consistent annual lengthening of wait times for treatment has made us sometimes forget that our system fails to deliver timely access to care and real people suffer as a result.

This is not OK. While some patients may be able to wait for treatment, others may experience considerable pain and discomfort, face worse medical outcomes, or be unable to use their time productively. Our recent study spotlights the economic cost of time lost while waiting for treatment. By combining estimates of the wait between specialist and treatment, the number of patients waiting, average wages, and the proportion of patients reporting that waits affected their lives, the estimated cost of waiting for care was $1.7 billion in 2016.

And this a conservative estimate, based only on hours lost during the average work week. By expanding the analysis to include the value of time lost during evenings and weekends (but still excluding eight hours of sleep at night), the estimated cost of waiting in 2016 rises to $5.2 billion. And this calculation still excludes the costs of care provided by family members, increased risk of mortality, and the wait to see a specialist in the first place. In fact, a 2008 study pegged the cost endured by patients waiting for just four medical procedures at $14.8 billion.

These numbers remind us that wait times are not benign inconveniences. Fortunately, they are not a necessary price to pay for universal health care. In fact, the Commonwealth Fund’s most recent survey clearly proves that other universal health-care systems (such as the Netherlands, Switzerland, Germany, Australia, and France) have much shorter wait times for health care than Canada.

They also do universal health care differently.

For example, they tend to embrace the private sector as a partner within their universal health-care systems, or allow it to operate as an alternative (like a pressure valve). They also generally require patients to share in the cost of treatment (to varying extents). This helps temper demand by reminding individuals that health-care resources are scarce and must be used responsibly. Of course, most countries that require such payments also incorporate various policies to ensure that vulnerable populations never face financial burden when seeking health care.

Another major difference involves the way hospitals are paid, with most other successful universal health-care systems using some form of “activity-based funding” that encourages productivity. This is in contrast to the prospective global budgeting system common in Canada, which helps control costs to an extent, but actually dis-incentivizes hospitals to treat patients who are seen as “costs.”

Ultimately, it’s up to Canadians and policymakers to decide which of these policies will work best in a Canadian context. However, the clock is ticking, and thousands of patients continue to wait to receive treatment. Many are in pain, many have medical conditions that are getting worse. And many are losing wages and time that could be used productively—or at the very least, in leisure with their families. We must not forget these Canadians and how they suffer due to our stubborn adherence to the status quo.

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