Canada’s health-care wait times hit new record high, again

We finally did it last year. In 2016, we hit the 20-week mark for the average wait time for treatment by a specialist (across 12 medical specialities) after referral from a general practitioner. Canada’s national shame had reached a record high of 20 weeks, a far cry from the 9.3-week wait measured by the Fraser Institute’s annual survey in 1993.

Bacchus Barua, The Fraser Institute December 7, 2017

One would have thought, nay, hoped, that this milestone would have served as a wake-up call to rally politicians and policymakers to improve the dismal situation faced by patients in our country. And yet, this year’s survey finds that wait times have gotten even worse. At 21.2 weeks, between referral from a GP to receipt of treatment, patients waited longer than ever for treatment in 2017.

Provinces such as British Columbia (26.6 weeks) and Alberta (26.5 weeks) have reached their own historic highs, Québec has broken the 20-week mark for the first time since 2003, and patients in New Brunswick can expect to wait almost a full year for treatment (41.7 weeks). In fact, in certain provinces, patients can routinely expect to wait more than a year to receive orthopedic surgery and neurosurgery. In many cases, physicians routinely report that their patients wait longer than they (physicians) consider clinically reasonable (never mind what patients would prefer if they had their way).

The simple question on everyone’s lips is why? Why do we wait so long, and why aren’t things improving? The answer is simple, but profoundly frustrating. It’s because policies have not changed.

Although we are now more aware than ever that universal health-care systems in other countries deliver more timely access to quality care at similar or lower costs, we continue to pursue the very policies that set us apart from them.

Instead of embracing the private sector as a partner, or even just as a pressure valve, defenders of the status-quo continue to demonize the private sector as antithetical to the very nature of universal health care. Yet, when we look at some of the more successful universal health-care systems such as Switzerland, the Netherlands, Germany, and Australia, we find that private insurers and providers are deeply woven into the fabric of their systems. For example, Switzerland ensures universal insurance coverage through a competitive (albeit, regulated) private insurance market. More than 40 per cent of hospitals in Germany are private, for-profit institutions.

Canadian policymakers are also obdurate in their rejection of co-payments and deductibles. While such payments are explicitly prohibited by the Canada Health Act (via threat of financial penalty to the provinces), they are routinely used in other universal health-care systems. For example, patients in the Netherlands can expect to pay a deductible before coverage begins. In addition to a deductible, patients in Switzerland are expected to pay 10 per cent of treatment costs. Of course, most of these countries also either exempt vulnerable populations, provide subsidies, or maintain an annual cap for total out-of-pocket expenses.

These differences, among others, between Canada’s system and other more successful universal health-care systems are generally tied to Canada’s stubborn adherence to a single-payer model. In Canada, government controls the purse strings, physician and patient incentives are obfuscated, and individuals are generally not allowed to pay directly for treatment within the country’s borders.

Of course, there are those who choose to ignore the plight of Canadian patients, and instead focus on discrediting the Fraser Institute’s survey methodology. Perhaps they would have more trust in data from the Commonwealth Fund, which recently ranked Canada last (among 11 countries including Switzerland, Germany and the Netherlands) in

• the ability of patients to secure a same or next-day appointment when sick,
• the wait for treatment in the emergency department,
• the wait to see a specialist, and
• the overall wait for elective surgery.

Or perhaps these same critics could simply listen to the thousands of Canadians waiting for treatment, including patients who recently took to Twitter (with the hashtag #CanadaWAITS) after Globe and Mail health reporter Andre Picard’s call for stories.

The fact is, when it comes to the specific way we structure our universal health-care system, we are not the norm, but rather the exception. Unfortunately, we pay for our exceptionalism with long wait times that have become the defining characteristic of Canadian health care.

Source The Fraser Institute via Maclean’s

Waiting your turn: wait times for health care in Canada, 2017 Report

Bacchus Barua, Fraser Institute December 7, 2017

Waiting for treatment has become a defining characteristic of Canadian health care. In order to document the lengthy queues for visits to specialists and for diagnostic and surgical procedures in the country, the Fraser Institute has—for over two decades—surveyed specialist physicians across 12 specialties and 10 provinces.

This edition of Waiting Your Turn indicates that, overall, waiting times for medically necessary treatment have in-creased since last year. Specialist physicians surveyed report a median waiting time of 21.2 weeks between referral from a general practitioner and receipt of treatment—longer than the wait of 20.0 weeks reported in 2016. This year’s wait time—the longest ever recorded in this survey’s history—is 128% longer than in 1993, when it was just 9.3 weeks.

There is a great deal of variation in the total waiting time faced by patients across the provinces. Ontario reports the shortest total wait (15.4 weeks), while New Brunswick reports the longest (41.7 weeks). There is also a great deal of variation among specialties. Patients wait longest between a GP referral and orthopaedic surgery (41.7 weeks), while those waiting for medical oncology begin treatment in 3.2 weeks.

The total wait time that patients face can be examined in two consecutive segments.

• From referral by a general practitioner to consultation with a specialist. The waiting time in this segment increased from 9.4 weeks in 2016 to 10.2 weeks this year. This wait time is 177% longer than in 1993, when it was 3.7 weeks. The shortest waits for specialist consultations are in Ontario (6.7 weeks) while the longest occur in New Brunswick (26.6 weeks).
• From the consultation with a specialist to the point at which the patient receives treatment. The waiting time in this segment increased from 10.6 weeks in 2016 to 10.9 weeks this year. This wait time is 95% longer than in 1993 when it was 5.6 weeks, and more than three weeks longer than what physicians consider to be clinically “reasonable” (7.2 weeks). The shortest specialist-to-treatment waits are found in Ontario (8.6 weeks), while the longest are in Manitoba (16.3 weeks).

It is estimated that, across the 10 provinces, the total number of procedures for which people are waiting in 2017 is 1,040,791. This means that, assuming that each person waits for only one procedure, 2.9% of Canadians are waiting for treatment in 2017.

The proportion of the population waiting for treatment varies from a low of 1.7% in Quebec to a high of 5.7% in Nova Scotia. It is important to note that physicians report that only about 11.5% of their patients are on a waiting list because they requested a delay or postponement.

Patients also experience significant waiting times for various diagnostic technologies across the provinces. This year, Canadians could expect to wait 4.1 weeks for a computed tomography (CT) scan, 10.8 weeks for a magnetic resonance imaging (MRI) scan, and 3.9 weeks for an ultrasound.

Research has repeatedly indicated that wait times for medically necessary treatment are not benign inconveniences. Wait times can, and do, have serious consequences such as increased pain, suffering, and mental anguish. In certain instances, they can also result in poorer medical outcomes—transforming potentially reversible illnesses or injuries into chronic, irreversible conditions, or even permanent disabilities. In many instances, patients may also have to forgo their wages while they wait for treatment, resulting in an economic cost to the individuals themselves and the economy in general.

The results of this year’s survey indicate that despite provincial strategies to reduce wait times and high levels of health expenditure, it is clear that patients in Canada continue to wait too long to receive medically necessary treatment.

Read the full report for 2017

Source The Fraser Institute

Also see
Canada should learn from countries that do universal health care differently—and better The Fraser Institute
Province can’t deny hospital overcrowding anymore CBC News
Five simple ways to improve Canadian health care Maclean’s
‘Discharge him at all costs’: A case study in overcrowding at Ontario’s hospitals The Globe and Mail
How quickly can you see a doctor? Study shows Canada lags behind other nations on timely access The Globe and Mail
Five things to know about Ontario’s new youth pharmacare program The Globe and Mail