Health-care wait times cost Canadians billions of dollars

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Appeared in the Ottawa Sun, May 17, 2023
Health-care wait times cost Canadians billions of dollars

While the pandemic is now squarely behind us, Canadian governments remain unable to deliver timely access to medically necessary elective (a.k.a. scheduled) surgical care. And a new study reveals the economic costs of these wait times on patients and the economy.

Last year, Canadians could expect to wait 14.8 weeks (on average) to receive treatment (e.g. orthopedic surgery) after seeing a specialist. This wait time was 164 per cent longer than the 5.6 week wait in 1993 and the longest in the survey’s more than 30-year history. As a result, patients were waiting for an estimated 1.2 million procedures in 2022.

Unfortunately, backlogs have been a feature of the system for decades and had already reached 1.1 million procedures in 2019 even before governments scaled back scheduled surgeries during the pandemic. While some provincial governments have successfully tackled their COVID-related backlogs, surgical backlogs remain a persistent feature of Canadian health care.

The 14.8 week wait between specialist to treatment is also considerably longer than what surveyed physicians consider clinically reasonable (8.1 weeks). Of course, unreasonably long waits for elective surgical care have physical and emotional consequences. In the absence of timely treatment, physical illness can progress, worsening patient health to the point of disability and even death. Patients, their families and caregivers may also experience anxiety and stress while waiting for treatment.

Moreover, waiting for care in a reduced physical state can impact the ability of patients to work, leading to economic costs. According to a new study published by the Fraser Institute, wait times for elective care in 2022 cost an estimated $3.6 billion ($2,925 per patient waiting) in lost wages and productivity. When we expand the analysis to include time spent by patients in a reduced state during their leisure time (while still excluding eight hours of sleep per night), this estimate balloons to $10.9 billion (or $8,897 per patient waiting).

And crucially, neither of these estimates include the average 12.6 weeks patients waited to see a specialist last year (after referral from a family doctor)—the cost estimates only apply to the wait between specialist appointment and treatment.

While advocates for the status quo often claim that rationing of care is an unfortunate but necessary price to pay for universal coverage, the experience of universal systems abroad demonstrates otherwise.

In 2020, the Commonwealth Fund found that Canadians were the least likely (at 38 per cent) to report a wait of less than four weeks for a specialist appointment when compared to nine other universal health-care systems. And only 62 per cent of patients in Canada reported waiting less than four months for non-emergency surgery, a much smaller percentage than in France (90 per cent), Switzerland (94 per cent) and Germany (99 per cent).

Why? They do universal health care differently than Canada and embrace the private sector as a partner or allow it to function as a pressure valve to ease the burden on the public system. They also expect patients to share the cost of treatment (while protecting vulnerable populations) and generally fund hospitals based on activity (unlike in Canada).

Unfortunately, not one provincial government is seriously pursuing these reforms. Even limited partnerships with the private sector in provinces such as Ontario and British Columbia have faced significant political opposition. And based on previous experience, increased spending from Ottawa (such as the recently re-negotiated Canada Health Transfer) will not be enough to create a modern high-performing system. So, while politicians continue the failed approach of increased spending without meaningful reform, the burden of these wait times fall squarely on the shoulders of patients.

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