The private cost of health-care queues in Canada

It’s no secret that Canadians face some of the longest wait times for health care in the developed world. In fact, according to the Fraser Institute’s annual survey of physicians, at 21.2 weeks from referral to treatment, Canadians waited longer in 2017 than ever before.

What’s often forgotten is that, for some patients, wait times can and do have serious consequences.

While this may be obvious for patients in need of critical care, it’s also true for Canadians waiting for medically necessary elective care such as hip replacements, hernia repair, cataract removal, aneurysm surgery and non-emergency pacemaker operations, for example. It’s estimated that more than one in 10 patients are adversely affected by waiting for non-emergency surgery. Physicians indicate that patients wait longer than what’s considered clinically reasonable. And of course, of the more than one million Canadians—including British Columbians—who waited for care in 2017, many would likely prefer to receive treatment earlier if possible.

The reasons are obvious. Patients waiting for treatment may be in pain, may be worried, and may have to depend on family or friends for assistance, or hire caregivers. In the most unfortunate cases, patients may also see their condition worsen, from a simpler and more treatable condition to a more complex, debilitating and perhaps permanent or fatal disability.

And then there’s the economic cost, in the form of lost wages and productivity. Based only on the wait from specialist consultation to treatment (10.9 weeks on average across Canada in 2017), and the number of hours in the normal work week, wait times cost the Canadian economy an estimated $1.9 billion—roughly $1,800 per person waiting. And this is a conservative estimate, which excludes the wait to see a specialist (10.2 weeks in 2017) and places no value on non-working hours spent pain-free. If you include hours outside the work week (while still excluding 8 hours for sleep), the cost of waiting goes up to $5.8 billion or roughly $5,600 per patient.

Of course, only patients experience the true cost of waiting for treatment. However, even rough estimates are useful to remind policymakers of the need for reform. Crucially, waiting is not a necessary price to pay for universal health care. Countries such as Germany, Switzerland, the Netherlands, Sweden, France and Australia all share the goal of universal access to care, spend about the same as we do, but don’t have our long wait times.

Why?

Perhaps because they do universal health care differently by embracing the private sector, expecting patients to share in the cost of treatment (with exemptions for vulnerable groups), and incentivizing hospitals to treat patients through activity-based funding by procedure or case, rather than “global budgets” common in Canada. Our closed government-heavy system stands in stark contrast to other universal health-care systems that have shorter wait times.

Sadly, the data have been clear for a long time. Despite spending increases, wait times for medically necessary elective treatment in Canada are remarkably long, and have been getting longer for years.

However, we must remember that these long waits are not simply statistics—they underscore the reality that many patients in Canada suffer pain and anxiety due to the current nature of our system. It’s time to do something about wait times by reforming policies, or at the very least, offering patients an alternative when they need it most.