McNeil government should allow private sector to help reduce surgery backlog

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Appeared in the Halifax Chronicle Herald, September 19, 2020
McNeil government should allow private sector to help reduce surgery backlog

As uncertainty over COVID continues, no one knows when things will be “normal” again. For patients in Nova Scotia, however, a return to normalcy will mean a return to the same overburdened health-care system and long surgical wait times, made worse by the pandemic.

While the story is similar across the country, data from Nova Scotia are particularly concerning. Earlier this year, the province postponed more than 3,200 scheduled surgeries due to COVID. Although, more than 41 per cent of these surgeries have now been completed, surgery volumes remain lower than the previous year. And while we of course commend Nova Scotia health-care workers for their work over the past few months, Nova Scotians will likely continue to face long wait times for care.

Consider that in 2019 patients in Nova Scotia waited 33.3 weeks for medically necessary elective treatment after getting a referral from their family doctor. Although the McNeil government may be tempted to address the current backlog by pumping more money into the system, this is not feasible. The province was already grappling with high debt levels before the outbreak and now faces a tidal wave of government debt from the COVID recession.

Moreover, increased spending may not be necessary. In fact, after adjusting for age, Canada (and its provinces) already spend more (as a percentage of GDP) on health care than most other universal health-care countries. Unfortunately, this high spending has not translated into superior performance. Again, after adjusting for age, Canada has fewer acute care beds (2.0 per 1,000, ranking 26th of 27), physicians (2.8 per 1,000 people, ranking 26th of 28), MRIs (10.4 per million, ranking 21st of 26) and CT scanners (15.9 per million, ranking 21st of 27) than most other high-income countries with universal care.

Canada also has significantly longer wait times than countries such as Switzerland (which spends slightly more, on an age-adjusted basis), the Netherlands, Germany and Australia (which spend slightly less). In fact, the most recent Commonwealth survey indicated that fewer Germans (0 per cent), Dutch (4 per cent), Swiss (6 per cent) and Australians (8 per cent) reported waiting longer than four months for elective surgery compared to Canada (18 per cent) in 2016, the latest year of comparable data.

So why is this happening? Why do we spend more while waiting longer?

One key difference is that these other universal systems embrace, to varying degrees, the private sector. Australia, for example, uses parallel private health care to augment its public system, allowing physicians to practice in both the public and private sectors, while also contracting out the delivery of services to private hospitals.

But we don’t need to look overseas for proof that third-party clinics can help reduce wait times. In 2010, the Saskatchewan Surgical Initiative used private clinics to provide publicly-funded surgeries and helped cut that province’s average wait times from 26.5 weeks in 2010 to 14.2 weeks in 2014—while offering services at a lower cost per procedure compared to public hospitals. British Columbia have already introduced limited partnerships with private clinics to help get through the COVID backlog while Alberta plans to follow suit.

To deliver more timely care to patients, and limit the pain and suffering of waiting, Nova Scotia should quickly enact similar reforms to help augment the public system, during the pandemic and beyond.

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