Waiting for Care, Waiting for Change
The first step to solving a problem is admitting you have one. In the case of medical waiting lists, it took Canadian governments, both federal and provincial, nearly 10 years to admit that patients were waiting too long for medically necessary services. After so many years of denial, theyve finally promised to do something about it.
Their goal is to develop a standardized way to measure waiting times, and to set medically acceptable benchmarks by the end of 2005. They also hope to reduce waiting times by then, though -- pledges of extra funding aside -- they dont actually have a concrete plan on how to do so.
But the data they hope to present late next year has been available to Canadians for more than 10 years. The Fraser Institute has been measuring and reporting on wait times in Canada using a standardized methodology since 1993.
In 2004, Canadians waited an average of 8.4 weeks from their general practitioners referral to an appointment with a specialist in 12 different medical specialties. They then waited another 9.5 weeks for their treatment -- 4.3 weeks more than physicians, on average, felt was reasonable.
At the same time that waiting lists have gotten longer, spending has been going up. In 1993, Canadians waited an average of 9.3 weeks between their GPs original referral and actual treatment. In 2004, Canadians waited a whopping 17.9 weeks, an increase of 92%. Yet in the decade to 2003, inflation-adjusted per capita spending grew nearly 26%.
Waiting lists are not a universal problem. Patients in Austria, Belgium, France, Germany, Japan, Luxembourg and Switzerland are all guaranteed access to health care regardless of their ability to pay. And yet they did not wait for elective care in 2004. Patients in these countries received the care they needed when they needed it -- an experience that would seem other-worldly to Canadians who typically wait almost 38 weeks for orthopedic surgeries and more than 11 weeks for elective cardiovascular surgery.
In 2001, the most recent year for which comparable data is available, not one of the above-listed nations spent more than Canada on a per-capita, age-adjusted basis for health services. In fact, Canada is the world spending leader when it comes to providing universal health care access. And yet Canada delivers long waiting times and only moderate health outcomes.
The data proves that health expenditures are not the problem in Canada. The problem is the way we organize our health care system. Consider what those other more successful countries are doing.
All of the countries without waiting lists require patients to share some of the costs of their health care. International evidence suggests that when patients are responsible for a portion of the cost of their care, they use fewer resources. This makes more resources available for other patients and saves money overall, but does not lead to poorer health outcomes.
Patients in these countries are also free to seek publicly funded care from either private or public providers. Unlike in Canada, the focus is on the appropriate, timely, effective and efficient delivery of services, regardless of who ultimately delivers them. As a result, all of these countries enjoy the cost savings and quality improvements that inevitably result from competition among providers.
Finally, all of these countries offer choice in the delivery of health care services by allowing a competitive privately funded health care sector -- care that is not paid for by the government. They understand that shackling patients to a public monopoly with no alternative choices results in a lower standard of care.
Waiting lists need not exist in Canada. With the right health policies, it is possible to have a universal-access health system that provides better care at lower overall costs. Getting there, however, will require rethinking our policies. Committing $41-billion of new spending to health care, as the provinces and federal government have recently done, is not part of that solution.
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