Our other, permanent health-care crisis

The sudden onset of the COVID crisis has devastated Canada’s economy. But another health- care crisis has been hurting Canadians and their country’s economic productivity for years — long wait times for medical care.

Health- care workers across Canada are doing great work to get us through the pandemic. And provincial health ministers have had to make difficult decisions in the past eight weeks, including cancelling thousands of elective surgeries and creating a backlog that will need to be worked through once the worst of the pandemic is over.

But even before COVID-19, Canadians have endured long wait times. For nearly three decades, the Fraser Institute has surveyed physicians across Canada to document wait times for medical procedures.

Last year’s survey revealed that on average patients faced a 10.8- week wait between seeing a specialist and beginning treatment — 92 per cent longer than in 1993 ( 5.6 weeks) when the first national estimates were calculated.

Though some of the estimated 1,064,286 Canadians who waited for medically necessary treatment in 2019 may not have experienced significant pain or disruption to their lives, others cannot have been so lucky. For many patients, wait times have serious consequences. Some Canadians wait in considerable pain and must deal with the physical and psychological suffering related to their illness. Others may experience poorer medical outcomes, permanent disability or even death.

Patient health should always be the primary concern. But long wait times also impose financial costs, both on patients and on the economy at large. A new study estimates that wait times cost our economy $ 2.1 billion — or $ 1,963 per patient — in lost wages and productivity in 2019. This rises to $ 6.4 billion if we include the hours patients spend in reduced capacity outside of work.

Moreover, neither estimate includes: the costs incurred by family members and friends acting as caregivers; the increased risk of morbidity and mortality; or any consideration of cost or inconvenience during the 10.1 weeks it takes on average to get to see a specialist in the first place.

A common defence of Canada’s wait times — that they’re a “necessary” price to pay for universal health care — is not confirmed by the experience of other countries with universal systems. For example, in 2016 significantly more Canadians ( 18 per cent) reported waiting four months or longer for elective surgery than was the case in other countries with universal coverage, such as Australia (8.0 per cent), Switzerland ( 6.0 per cent) and Germany (0 per cent — yes, zero per cent). Though citizens of many of these countries will likely experience increased wait times for treatment, given COVID- related delays in elective surgeries just about everywhere, most will start from a much shorter baseline wait than Canadians.

So how do these countries ensure timelier access on a routine basis? Simply put, they approach universal health care differently than we do. For example, they expect patients to share the cost of care and generally incentivize hospitals to treat patients using an “activity- based” funding arrangement, which is much different than Canada’s “global budgeting” approach.

They also embrace the private sector as either a partner or an alternative to the public system. Following a similar approach in Canada would produce several advantages. First, by contracting services out to existing private clinics, our public health- care system could serve more patients ( including those whose surgeries have been postponed) without having to invest in expensive infrastructure. Second, allowing patients to pay for treatment privately would let the private sector act as a pressure valve, alleviating stress on the public system. Third, an independent private sector would not directly compete with other social programs or be bound by government budgets.

The desperate times we are living through may well call for desperate measures, including a pause on elective surgeries. But the important if uncomfortable question remains: What happens next? How do we address the surgery backlog? Will patients simply be added to already long waiting lists? Or will governments finally consider fundamental policy reforms?

LONG WAIT TIMES ALSO IMPOSE FINANCIAL COSTS, BOTH ON PATIENTS AND ON THE ECONOMY AT LARGE.