While politicians dither, patients die

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Appeared in Alaska Highway News

Over the past two decades, the general Canadian attitude toward wait times for medical treatment seems to have evolved into a resigned acceptance of this ostensibly “mild nuisance” in an otherwise excellent system.

It’s time for a reality check.

Since 1993, the average wait for treatment has almost doubled (to 18.2 weeks in 2013), per capita public healthcare expenditures have increased by about 40 per cent (after adjusting for inflation), and it is becoming increasingly apparent that patients are suffering the consequences.

And yet, there is no real indication that politicians intend to introduce meaningful reforms to solve this problem.

It seems we have become comfortably numb to this fundamental flaw that is now a defining feature of Canadian healthcare.

Unfortunately, wait times are not benign inconveniences – especially not when they are as long and ubiquitous as those in Canada. Many patients face physical pain and suffering, mental anguish, and lost economic productivity (about $1,200 per patient) while waiting for treatment in this country.

For example, Statistics Canada found that about one fifth of patients who visited a specialist, and about 11 per cent of those waiting for non-emergency surgery, were adversely affected by their wait. Many reported experiencing worry, stress, anxiety, pain, and difficulties with daily activities.

Protracted wait times may also result in potentially treatable illnesses and injuries becoming chronic, permanent, debilitating conditions. In such circumstances, requiring patients to accept inordinately long waiting times, without the opportunity to seek alternative treatment denies them their basic human right to lead healthy lives (as recognized by the Supreme Court in 2005). It is precisely for this reason that Dr. Brian Day, former head of the Canadian Medical Association, is fighting a court case in British Columbia to allow private treatment for those patients who have fallen through the cracks of the public system. One of his co-plaintiffs has already died while waiting for the trial, while another is permanently disabled because of neglect on the public wait list.

Sadly, their stories are not isolated cases. In a recent study, Nadeem Esmail, Taylor Jackson and I investigated whether the changes (mostly increases) in wait times between 1993 and 2009 had any impact on mortality rates. After controlling for relevant factors (physicians, health expenditures, age, Gross Domestic Product, inequality, and gender), we found that there was, indeed, a statistically significant relationship between wait times and the incidents of female deaths.

Specifically, after crunching the numbers we estimated between 25,456 and 63,090 Canadian women may have died as a result of increased wait times during this period. Large as this number is, it doesn’t even begin to quantify the possibility of increased disability and poorer quality of life as a result of protracted wait times.

Clearly, wait times may have serious consequences for some patients. It is inhumane and immoral to force these patients to choose between long waits in the public system (risking their health and well-being) and leaving their homeland (and families) to seek treatment elsewhere.

Fortunately, the noble goal of universal healthcare can be achieved without paying for it with patients’ lives. In fact, the experience of other countries suggests that wait times and single-payer insurance are neither necessary, nor common features of successful universal healthcare systems around the world. Data from the Commonwealth Fund, and studies by Fraser Institute have repeatedly shown that countries like Switzerland, the Netherlands, Germany, Japan and Australia ensure universal healthcare for their residents without the long wait times found in Canada.

How do they do it? By encouraging competition between regulated private insurers, requiring patient cost-sharing (through co-payments and deductibles with annual limits), and replacing global budgets with activity based funding for hospitals (so that money follows the patient).

Defenders of Canada’s status quo will likely balk at these suggestions and cling to their dream of government-delivered universal healthcare – ignoring the fact that it simply doesn’t work for many patients. But those who are pragmatic, and truly committed to fixing our broken system, should seriously consider implementing reforms that seem to have worked in other countries that are equally committed to universal access to health care.

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