Medically Acceptable Wait times Not Acceptable

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Appeared in the Ottawa Citizen, 02 December 2006
Earlier this week The Wait Time Alliance, a group of Canadian physician associations, released a report grading the provinces’ performance on wait time benchmarks (both the Alliance’s and the government’s own) and commitments. Provincial grades ranged from As to Fs, indicating some provinces are doing well while others lag behind. Thankfully most are now at least measuring and reporting wait times publicly. The harsh reality however is the Wait Time Alliance has rather low expectations. Even if the wait time targets are met, every province will continue to fail patients when it comes to providing access to health care services.

All current and proposed wait time initiatives in Canada are pursuing a similar strategy: to determine what a medically acceptable or maximum allowable wait time is, and then work towards ensuring that Canadians wait no longer than those ‘acceptable’ wait times. The key assumption being that patients will always be waiting for treatment in Canada.

Of course, it is perfectly acceptable to have some lag between the time a patient’s need is identified and when they get treatment, just as we experience some waits to see our dentist or our car mechanic. However, those latter waits are driven by scheduling issues and the services are ultimately delivered within a few days of when we desire them. Canadians do not wait for long because the service providers have adequate capacity, and are given the appropriate incentives to respond to our needs.

By contrast, the Wait Time Alliance and Canada’s governments think that long wait times are “acceptable” if they do not lead to serious negative health consequences. Put another way, under the wait times they deem acceptable, you might not die, nor might your condition deteriorate significantly. But what is being quickly forgotten in Canada is that any wait for care involves pain and suffering, lost productivity at work and leisure, mental anguish, and additional strain on personal relationships. The best wait time for patients is not the one that minimizes medical harm, but the one that minimizes waiting altogether. A truly patient focused health care system, one that is truly deserving of the title “world class,” is one that delivers care without systemic delay.

Part of the problem here is that we have given in to the problem before we start. There is no thought being given to the possibility that the only acceptable wait is no wait. The Health Council of Canada has pointed out that it would be “inefficient” to have all those medical resources just waiting around for people to get sick…unthinkable. Or is it?

While the idea of receiving treatment in such a time frame may seem the impossible dream to some Canadians, such on demand treatment is already being delivered elsewhere in the developed world. Patients in Austria, Belgium, France, Germany, Japan, Luxembourg, and Switzerland enjoy access to health care (regardless of ability to pay) with only short waits for treatment – like the scheduling waits we are familiar with for the other services we need. Further, the cost of these health care programs is, on an age-adjusted basis, similar to or less than the cost of Canada’s Medicare program, so achieving similar success in Canada does not require increasing this nation’s already high level of health spending.

Rather, this admirable performance comes from a commitment to health care models that rely on competition and appropriate incentives. Unlike Canada’s Medicare each of these nations relies on private competition in the hospital care sector, on user fees for medically necessary services, and on a parallel private health care sector to ensure that patients of all incomes get access to the very best care in a timely fashion. Such policies lead patients to make more informed decisions when seeking care and give providers the incentive to deliver more health services at higher quality and more efficiently than they would otherwise.

And therein lies the real solution to Canada’s wait time problem. Rather than pursuing management programs, big wait list registries, and benchmarks, the provinces should be following the guidance of the world’s leading health care programs and focusing on what is best for the patient. Of course, that would mean abandoning the status quo and moving to a set of guiding health policies that are based on sound principles which have proven to be immensely successful in other developed nations’ universal health care systems.

While our provinces and federal government should be applauded for acknowledging there is a problem and actually attempting to do something about it, it took them too long to react. And now they are proposing benchmarks for improvement that fall well short of the international gold standard. All of their actions are based on the premise that Canadians must wait for care and will always wait for care. International evidence and experience suggests that such a fundamental belief is flawed: it is possible to give patients excellent access, on their own terms, to a responsive, efficient, and high quality health care program. But doing so will require an informed and honest debate about what works, rather than a blind commitment to managing what doesn’t.

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