Despite spending $134 billion more, health care waits remain

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posted November 6, 2013

In most places, if you spend more, you receive more in goods or services. The glaring exception is Canada's government-run health care system.

Consider this fact: Canada's provinces spent $134 billion more on health care between 2004 and 2012 than needed to keep up with inflation and population growth. Despite that infusion of cash, wait times for medically necessary treatment in 2013 are about as long as ever. In fact, at 18.2 weeks (between referral from a general practitioner to treatment) national wait times this year are actually slightly longer than they were in 2004 (17.9 weeks), and almost twice as long as they were in 1993 (9.3 weeks).

It doesn't have to be this way. By tackling the policies that created the health care queues in the first place (lack of competition, lack of cost sharing, predominance of government), provincial governments can provide more timely access to health care without placing greater demands on taxpayers all within the context of universality.

What governments mustn't do is keep going with things the way they are.

Here's why: the wait-times for medically necessary treatment in Canada are bad enough as stand-alone facts. The facts look even worse in an international perspective.

Canada's health expenditures as a share of the economy are, after accounting for our younger population, higher compared to every other developed nation with universal health insurance. Yet Canadians endure some of the longest delays for emergency care, primary care, specialist consultations, and elective surgery in the developed world.

Too often underappreciated is the destructive personal price paid by ill Canadians while they wait for treatment. Delayed access to medically necessary care can result in deterioration in the patient's health - sometimes requiring more difficult treatments and resulting in a poorer prognosis by the time the individual finally gets to the front of the queue. In some cases, delay may even lead to permanent disability or death.

If that isn't a description of a failing health care system, what is?

No doubt some politicians and the usual defenders of the status-quo will respond to these depressing realities with the notion that 'strategic' investments in health care (ie. throwing money at the problem) and better government management will solve all that ails us. Tragically, what they won't admit is that none of this has really worked - Canadians are still faced with the same lengthy delays in spite of all the spending, managing, and limited reporting that has taken place.

For the sake of everyone's health and well-being, it's time Canadians put a stop to the spend-more, wait-more cycle, and instead adopted European policies that could meaningfully and permanently improve access to care.

A recent comprehensive review of wait times policies edited by Professor Steven Globerman found that competition in the provision of universal care with money following the patient leads to shorter wait times even in tax-funded/government-run health insurance schemes. A deeper look at the experiences of nations with universal healthcare, but without lengthy wait times (Belgium, France, Germany, Japan, Luxembourg, the Netherlands and Switzerland) finds that cost sharing, private competition in financing and delivery, and de-politicization of health care insurance can lead to the virtual elimination of health care queues.

Vitally, by the way, there is no evidence to support the fearmongers who rage against health care reform in Canada. Instead, private competition and money-follows-the-patient funding in these European nations produced shorter wait times with universality intact.

Canada's lengthy wait times result from a preponderance of government micromanagement in the financing and delivery of health care. Nowhere else in the developed world are citizens so dependent on government for access to medically necessary care - effectively rendering them prisoners to political wrangling and the bureaucratic will. Other nations deliver more timely universal access to care without spending more than we do. They do it by getting governments to focus on a useful and essential role, regulation and oversight, and then employ private competition and appropriate financial incentives to deliver more timely, higher quality care.

Lengthy delays for treatment waste and destroy the lives of Canadians stricken with illness. Yet governments continue to fail Canadians by pouring money into a system that produces subpar results, and refusing to budge from the status quo. Better understanding and adopting policies that have improved timeliness within a universal construct would far better serve Canadians stricken with illness than another defense of the destructive status quo. Long waiting lists for access to medically necessary care are Canada's shame, but they can be fixed.

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