William Watson: Tick-tock, ka-ching, ka-ching—the cost of waiting for health care in Canada
Perfectly fittingly, this week I read the Fraser Institute study by Bacchus Barua and Feixue Ren on the cost of health-care waiting lists while I was waiting to renew my “Carte soleil,” my Quebec medicare card. My wait ended up to be 80 minutes, so I had time to read the study several times.
Once I got to the front of the line the process took only about three minutes (including having my picture taken; for some reason the government wants documentary evidence of my aging). But when I had arrived I got number 128 only to see that the two clerks on duty were working on number 93. This was at one of only four outlets that do medicare renewals in the administrative area of Montreal (population 890,000). It turned out, lucky for me, that there weren’t actually 35 people in front of me, about a dozen evidently took a number but gave up before it was called. So things moved along not too badly, considering.
As the ticker counted up to 124… 125… 126, I wondered, as any self-respecting economist would, whether I should announce to the room that I was willing to sell my number 128. What would people have paid to move to the front of the line?
I’d have had to tell them how much time I thought they’d be saving, given the number they had drawn. Maybe they’d believe me, maybe not. But then I asked myself how much they’d have to pay me to make it worthwhile for me to sit back down and wait another 80 minutes. It was a non-teaching day for me. I could have turned my iPad back on and read another Fraser Institute study or the always interesting columns in the National Post or something from Kindle. But I fairly quickly concluded I’d have to get much more than they’d likely be willing to pay in order to stay.
My contemplated auction of my number would have generated exactly the kind of data we’d like to have in assessing the cost imposed on people having to wait for medically necessary specialist treatment, the problem Barua and Ren looked at. How much would people be willing to pay in order to eliminate their wait?
If it’s costing them time at work and therefore lost wages, or if they’re suffering pain and stress as well as inconvenience to themselves and to family members and others who have to take care of them, they might be willing to pay a lot. If they could get rid of all that trouble by in effect buying the next ticket to be called instead of whatever ticket they have, then it would make sense to pay up to the total value of their hurt, but not more—if they have to pay more, then the cost of waiting is less than the cost of moving up so they would wait.
Unfortunately, information of that sort isn’t readily available. It would be great if it were but it isn’t. So instead what Barua and Ren focused on was how much time and income people would lose when waiting for treatment. Multiplying the median wait time for people waiting for different treatments, times the number of people waiting—fully 2.7 per cent of Canadians—times the average weekly wage, and then taking 11 per cent of that, they calculated that in 2014 the total cost of waiting, countrywide, was $1.208 billion.
Why take 11 per cent of it? Because in a 2005 Statistics Canada survey 11 per cent of respondents said they were adversely affected by their wait for non-emergency surgery. In fact, a 1990 Fraser Institute study by Steven Globerman and Lorna Hoye found that the incidence of harm was much greater, 41 per cent on average. But Barua and Ren decided that medical technologies had changed a lot in the last 25 years so they had better use the more conservative estimate of 11 per cent. (I remember 1990: how did it get to be 25 years ago so quickly? The medical innovation we really need is something that will work against the too rapid passage of time!)
If 2.7 per cent of Canadians are experiencing harm that they might plausibly be willing to pay $1.208 billion to get rid of, that’s something governments should pay attention to.
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