B.C. can tackle health-care wait times by learning from more successful universal systems
According to a recent announcement by the Horgan government, British Columbia’s health-care system has completed 91.6 per cent of the surgical backlog resulting from the postponement of non-urgent surgical procedures during the pandemic. While this is a remarkable achievement, according to the province’s official figures, at least 88,300 patients continue to languish on B.C’s surgical wait lists, equal to about one-fourth of all scheduled and unscheduled surgeries (337,560) performed since last March. Clearly, B.C.’s struggle with long wait lists is not over.
It is, however, important to give credit where it’s due. An estimated 32,400 surgeries were postponed during the first wave of COVID, with thousands more to follow. Getting through this backlog is no small feat. Further, despite its staggering size, the government’s estimate of the current wait list is actually 6 per cent smaller than the pre-pandemic “backlog” in 2019/2020 when 93,903 were reported to be waiting for treatment.
While commendable, this actually suggests a more fundamental problem that predates the pandemic.
For example, although the Fraser Institute’s annual survey of physicians reported a median wait of 26.2 weeks between seeing a general practitioner and receiving treatment in 2021, the same survey reported a median wait time of 24.0 weeks in 2019—before the pandemic started. In fact, the longest wait times in the province were recorded in 2017 (26.6 weeks). In other words, COVID-19 exacerbated, but did not cause, long wait times in B.C.
While much remains to be done to help those still waiting, it’s worth examining how the province cleared its backlog.
Although a healthy injection of health-care dollars ($187.5 million since 2020) was instrumental, B.C. also contracted private surgical clinics to complete publically funded surgeries. Announced as one component of the original plan in 2020, these clinics have completed 13,863 surgeries during the 2020/2021 fiscal year. Clearly, these clinics were able to immediately provide additional capacity to deliver procedures to patients in need.
Which raises the key question. Why aren’t such clinics used routinely to tackle long wait times in the province?
There’s certainly enough evidence of their value. Indeed, private surgical contractors have a history of success in other provinces. For example, the Saskatchewan Surgical Initiative, which was introduced in 2010 to help reduce that province’s lengthy wait times, contracted private surgical clinics to perform select day surgeries funded by the public purse. These partnerships, alongside other important reforms (such as centralized patient referrals), took Saskatchewan from the highest median wait time outside of Atlantic Canada (26.5 weeks in 2010) to the second shortest in 2014 (14.2 weeks). Even more remarkable was the ability of these programs to reduce costs by an average of 26 per cent per procedure.
Unfortunately, this success only lasted for the life of the program, which ended in 2014. By 2019, Saskatchewan’s wait times had crept back up to a median of 26 weeks. The lesson for B.C.? The current progress, due in part to private surgical clinics, will likely be temporary without permanent reforms.
Finally, it’s worth noting that provincial health-care systems in Canada continue to operate in stark contrast to other more successful systems around the world. For example, countries such as Switzerland, the Netherlands, Germany and Australia all spend the same or less than we do, and all embrace private insurers and providers as fundamental components to their system, as both a partner and pressure valve. These countries also expect patients to share the cost of care to incentivize patients to make more informed decisions about when and where it’s best to access health care (while exempting vulnerable populations). And they also fund their hospitals based on activity to incentivize treatment. (Canada, on the other hand, largely funds its hospitals via “global budgets,” which reduces the number of procedures performed, although this will soon change in Quebec.) As a result, these other countries virtually eliminate queueing for health care, which is delivered to everyone regardless of ability to pay without undue delay.
The Horgan government has worked hard to the address the many challenges, including the backlog, the pandemic wrought on B.C.’s health-care system. To improve on and cement this progress, it should consider additional reforms based on policies employed by other more successful universal health-care systems.