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Hold the Applause, Please

Appeared in the Okanagan Sunday
Release Date: October 14, 2008

This year, Canadians experienced the first notable decrease in the total wait time for medically necessary treatment since the Fraser Institute began producing Canada’s only national, comprehensive, and comparable measurement of wait times in 1993.

Across Canada, the waiting time from a GP’s referral to the time treatment is provided by a specialist was a full week shorter in 2008 than it was in 2007, having fallen to 17.3 weeks nationally. No doubt many politicians will be publicly celebrating their governments’ achievements in this regard in the coming days. Canadians should not be misled.

First, this small improvement is nothing to shout about. While wait times have fallen roughly seven days, they still remain high across Canada. The 17.3 week wait time is 86 per cent longer than it was 15 years ago, when it was just 9.3 weeks long.

Second, the greatest decrease in wait times comes in an area where Canada’s provincial and federal governments have paid little attention. Specifically, the improvement in the national wait time was primarily driven by an improvement in the time waited to see a specialist after a GP’s referral, which fell by a little less than 0.7 weeks between 2007 and 2008.

Governments at both the provincial and federal level have paid little attention to this part of the total patient experience, and have instead focused the majority of their efforts on the wait time between specialist consultation and treatment. That wait time fell by slightly less than 0.4 weeks.

Third, waiting times from specialist to treatment continue to be markedly longer than physicians feel is clinically reasonable. Consider that the actual wait time for Canadians from specialist to treatment in 2008 was 8.7 weeks while physicians suggest a wait of six weeks is clinically reasonable. It is worth noting that Canada’s specialists tend to be stricter with their definitions of what is a clinically reasonable wait time than our provincial and federal governments with their wait time benchmarks.

Fourth, and perhaps most critically, a seven day improvement in a 128 day wait time falls well short of what should be the goal in Canada: delivering timely access to health care.

Any wait time, even a short one, entails some amount of pain and suffering, mental anguish, lost productivity at work and leisure, and strained personal relationships. Wait times can also take a toll on the family and friends of those waiting, and may even have an effect on an individuals’ ability to provide for themselves and their loved ones. Looked at from the patient’s perspective, it quickly becomes clear that the only acceptable wait time is no wait at all.

And while some Canadians might consider this the impossible dream, several nations are already delivering that level of access to care for their citizens. Like Canada, Austria, Belgium, France, Germany, Japan, Luxembourg, and Switzerland maintain universal access health insurance programs. Very much unlike Canada however, individuals in these nations receive access to health care services without queues.

Canada’s poor performance on wait times is happening at the same time as our governments are committing record amounts of our tax dollars to the health care system. In 2007, provincial and territorial health expenditures were more than 28 per cent higher than in 2000, after accounting for inflation and population growth. Note also that the total wait time in 2000-01 was 16.2 weeks, more than seven days shorter than what it is in 2008.

In all, a careful look at Canada’s performance on waiting times for medically necessary health care services reveals little for governments to celebrate and even less for Canadians to be proud of. To the contrary, that careful examination should bring Canadians to the conclusion that governments of all stripes across Canada are continuing to fail them when it comes to providing timely access to the care they require. All of Canada’s governments and federal parties seem committed to the status quo, which has proven to be incapable of delivering timely access to care despite high levels of expenditure.

Canadians deserve better.

Nadeem Esmail is the Director of Health System Performance Studies at the Fraser Institute and co-author of Waiting Your Turn: Hospital Waiting Lists in Canada, available at