Ontario's Top Ranked Performance is Not a Success Story

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Appeared in the National Post, 09 November 2006
In 2006, Ontario was ranked first in Canada with the lowest wait times for medically necessary treatment according to The Fraser Institute’s annual survey of hospital waiting lists. Ontario’s performance was aided by an eight per cent overall improvement in waiting time and a 14 per cent improvement in the wait time from specialist consultation to treatment. Indeed, things seem to be improving in Ontario—a good thing for patients.

However, if truth be told, Ontario’s improvement and top-ranked performance in Canada is nothing to celebrate. The real test for timeliness should not be who is best in Canada but rather, who is best among all of the world’s most developed nations that guarantee access to comprehensive health care services regardless of ability to pay. And by this standard, Ontario and all Canadian provinces are failing the test and have been since at least 1993.

Consider that Ontarians, just like Canadians in every other province, are now paying more for health care (inflation adjusted total per person expenditures) than ever before. Nationally, total health expenditures per capita (inflation adjusted) are up by four per cent between 2004 and 2005, and up 46 per cent since 1990. Despite this high level and growth in spending, the overall provincial waiting time from specialist consultation to treatment in Ontario is still 50 per cent longer than the wait doctors consider clinically reasonable. The total wait time, from referral by a general practitioner to treatment, (14.9 weeks) is also 64 per cent longer than it was in 1993 when it was 9.1 weeks. Nationally, the 2006 average wait time (17.8 weeks) is a remarkable 91 per cent longer than it was in 1993 (9.3 weeks).

Further, Ontario’s performance is not the result of spending more on health care than other provinces. In terms of age and sex adjusted per person provincial expenditures on health care, Ontarians actually spent 11 per cent less than Albertans (2nd shortest waiting times) and six per cent less than Manitobans (3rd). This disconnect between health expenditures and waiting times also occurs at the national level. Canada spends more (age adjusted) than 25 of the 28 world’s most developed nations that have 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 in Canada, but the structures of their programs are entirely different. Unlike Canada, these countries employ private competition and appropriate financial incentives for both patients and providers as core health policies. The result is timely, effective, and efficient delivery of high quality services for all patients regardless of their ability to pay.

Private competition in the health care sector has brought great benefits to the citizens of these nations. Some of these benefits come from private care providers, who deliver publicly funded surgeries and other services on a competitive basis. Both economic research and international evidence have shown that the competitive private provision of services is more cost-efficient and produces a higher quality of care than the monopolistic public provision of services that exists in Canada.

Benefits also come from competition in the funding of care. Patients in these nations are free to buy private medical insurance or directly purchase health care services. 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. According to research and international evidence, when patients are responsible for some of the cost of their care, they make more informed decisions about when and where it is best to access the health care system (improving access for other patients and saving money overall) and end up no worse off in terms of health outcomes as long as low income populations are exempted from the cost sharing scheme.

The evidence from Europe and elsewhere in the developed world clearly demonstrates that wholesale reform of our universal access health insurance programs based on the principles of competition and appropriate financial incentives will greatly improve access to necessary health care services for all Canadians.

Ontarians should not be celebrating a 15-week waiting time, even if it is the shortest in Canada and an improvement over last year. 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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