Waiting for Care is Not A Good Thing

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posted April 2, 2004

In Tuesday’s edition of the Free Press, Dr. Gordon Guyatt wrote about the benefits of substantial waits for medical services (“Health-care wait is worth it”, March 16). His thesis was that waiting lists are good for the health of both patients and the public health system. Unfortunately, Dr. Guyatt has missed a number of important facts about waiting times in Canada and that there is a better and more compassionate way to deal with excess use of health services.

How long are patients forced to wait? The Fraser Institute’s annual publication, Waiting Your Turn, provides the only national measurement of waiting times for necessary medical procedures in Canada. According to the latest measurement -- based on the responses of 31 percent (nearly 1/3) of the medical specialists across Canada -- Canadians wait slightly more than 4 months from the time their general practitioner refers them for treatment to the time a specialist delivers the care. Most of these patients would feel no better if told that their waiting times were somehow beneficial to them.

Not only are these wait times unacceptably long for individuals experiencing the pain and mental anguish of needing care, they are also long compared to what physicians feel is appropriate. In 2003, actual waiting times for medical services in Canada exceeded the times physicians felt were clinically “reasonable” in 92 percent of the 12 medical specialties and 10 provinces surveyed. Further, the peer-reviewed literature comparing wait times internationally has found Canadian waiting times to be among the longest in the world. (In spite of the fact that the Canadian health care system is tied with Iceland as the most expensive universal access health care system in the OECD on an age-adjusted basis).

Dr. Guyatt points out that substantial waiting times, which are purposely built into our health care system, allow physicians to prioritize patients and decide what services patients truly require, particularly in the more discretionary areas of elective care and doctor’s visits. Of course, this statement ignores the evidence published by Canadian physicians that has found patients accessing faster care for health services because of personal connections or clout. Canadian physicians also found no connection between the times waited for orthopaedic surgery and amount of pain patients are experiencing in Ontario, a finding that is likely just the tip of the iceberg.

But there is something more important Dr. Guyatt has missed: there are far better and more compassionate ways to ration care than through waiting lists.

The idea behind the “necessity” of waiting is that patients and physicians will access discretionary and diagnostic services with reckless abandon unless something is done to constrain their use. In the private marketplace, use is constrained by the cost of services. The opposite of this is the management of use through either access restrictions (undersupply of services as in Canada) or through excessive bureaucratic oversight of physicians’ activities.

In between the two extremes falls one of the most promising reforms for Canadian health care, a policy most member countries of the Organisation for Economic Cooperation and Development (OECD) have chosen to include in their public health insurance programs. Of the 28 OECD countries that share Canada’s goal of providing care on the basis of need and not ability to pay, 23 have some form of cost sharing program for patients covering hospital and physician services, and, in many cases, emergency room visits.

All of these countries have realized what economic experiments and international evidence have shown for years: making patients responsible for some of the cost of their care leads to more informed decisions about when and where the health care system is accessed. Such fees have also been shown not to cause negative outcomes as long as individuals with low-incomes are exempted.

In such a system, where patients access services less frequently than when it is free at the point of access (as in Canada), long waiting times would no longer be necessary to manage demand.

A universal access health care system with responsible patients and easy access to all health services, without waiting, should not be the exclusive realm of patients in countries like Japan, a country with some of the best health outcomes in the OECD and one of the lowest levels of health expenditure. Canadian patients deserve the same standard of care, not just for medical reasons like faster and better diagnoses of conditions but also for personal reasons like the alleviation of the mental anguish of people waiting for cancer treatment or the diagnosis of a potentially cancerous lump. Such a system is also what Canadian taxpayers have been funding for years.

Waiting lists should not be necessary in a modern and well functioning health care system. A program where patients are responsible for some of the cost of their care, and where patients have access to the very best medicine has to offer at their own discretion should be. Waiting for care, all types of care, is the problem in Canada, not the solution.

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