Manitoba's Waiting Lists are Not a Success Story

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Appeared in the Prince Albert Daily Herald, 23 October 2004

Canadians are waiting longer and longer for care with every year that passes. But hidden within the continuously increasing national wait times, now 17.9 weeks in total, are remarkably disparate performances among Canada’s ten provinces. This year, it was Manitoba’s first place performance that seemed to catch the interest to Canadians. In the latest wait time measurements, Manitoba beat second-placed Ontario’s wait times by 5 percent, and neighbouring Saskatchewan’s by an incredible 55 percent.

A number of Canadians have gone so far as to suggest that this first-placed performance is an example of success. Truth be told, Manitoba’s performance is nothing to celebrate.

Manitobans, just like Canadians in every other province, are now paying more for health care (inflation adjusted per person expenditures) than ever before. Despite this high level of spending, waiting times in Manitoba are still 43 percent longer than those that doctors consider clinically reasonable.

Manitoba’s performance is not the result of spending more on health care than other provinces. Though Manitoba does spend (age and sex adjusted) more than last-placed Saskatchewan, Manitoba actually spends 7 percent less than Alberta (the province with the 3rd shortest waiting times) and 9 percent more than Ontario.

This disconnect between health expenditures and waiting times also occurs at the national level. No nation spends more than Canada (age adjusted) for a universal access health care system, and yet Canadians experience some of the longest waiting times in the developed world.

Obviously, it’s not how much Canadians are spending that is the problem. The real problem is the structure of our health care system itself.

Patients in Austria, Belgium, France, Germany, Japan, Luxembourg, and Switzerland receive their health care with virtually no waiting times at all. The health care programs in these countries deliver care on the basis of need and not ability to pay, just as is done in Canada, but their focus is entirely different. Unlike Canada, where the focus seems to be on how much we spend and who delivers health services, these countries focus on the appropriate, timely, effective, and efficient delivery of high quality services.

Focusing on the care actually delivered to patients, and not on who delivers it, has brought great benefits to the citizens of these nations. Some of these benefits come from private care providers, who deliver publicly funded surgeries on a competitive basis. Both economic research and international evidence have shown that the competitive private provision of services is vastly superior to the monopolistic public provision of services, both in terms of cost and quality of care.

More benefits come from competition in the funding of care. Patients in these nations are free to purchase health care services and insurance privately if the public health program is unwilling to meet their needs. The Canadian public monopoly in health insurance, just as with a non-competitive hospital sector, means a more expensive and lower standard of care than would be available otherwise.

Finally, benefits also come from sharing the costs of care with patients. When patients are spending their own money to receive services, even if they are funding only a portion of their care, they will make more informed decisions about when and where it is appropriate to access the health care system and the health care system in its entirety ends up less expensive because of the reduction in total use. The international evidence on cost sharing shows that no one will suffer worse health outcomes resulting from foregone care as long as low-income groups are exempted.

Clearly, there are great benefits resulting from the use of these very successful policies. Policies that are in place in all of the world’s most successful universal access health care systems. Such policies not only generate immense benefits for patients in terms of quicker access to better care, but also generate savings for the taxpayers who fund their care.

Manitobans should not be celebrating a 15 week waiting time, even if it is the shortest in Canada. Taxpayers in Canada are paying more than enough to deliver universal access to health services without waiting times. All we need is the right health policies to make it happen.

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