The ‘other’ health-care crisis damaging our economy—every year

The COVID pandemic has devastated Canada’s economy and the recovery will be long and uncertain. However, another health-care crisis has been hurting Canadians, and the country’s economic productivity, for years—long wait times for health care.

Of course, 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 during this time, including the decision to cancel thousands of elective surgeries, thereby creating a growing backlog that must addressed 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 patients faced a 10.8 week wait (on average) for treatment after seeing a specialist—92 per cent longer than in 1993 (5.6 weeks) when the first national estimates were calculated.

While some of the estimated 1,064,286 Canadians who waited for medically necessary treatment in 2019 may have endured the long wait without significant pain or disruption to their lives, others surely were not as lucky. Wait times can and do have serious consequences for many patients. 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.

The health of patients should always be the primary concern. But long wait times also impose financial costs on patients and the economy at large. In fact, 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 figure increases to $6.4 billion if we include the hours patients spend in reduced capacity outside of work (excluding eight hours of sleep a night).

Notably, neither one of these estimates include the costs incurred by caregivers such as family members and friends, the 10.1 weeks it takes to first see a specialist, and the potential for increased risk of morbidity and mortality.

A common defense of Canada’s wait times, that they’re a “necessary” price to pay for universal health care, falls short when you account for the experience of other countries. For example, significantly more Canadians (18 per cent) reported waiting four months or longer for elective surgery in 2016 compared to other universal health-care systems such as Australia (8 per cent), Switzerland (6 per cent) and Germany (0 per cent).

And crucially, while many of these countries will likely also experience increased wait times for treatment given their own COVID-related delays in elective surgeries, most will start from a much lower baseline wait compared to Canada.

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.

Importantly, each country also embraces the private sector as either a partner or an alternative to the public system. There are a few potential advantages for Canada to follow a similar approach. First, by contracting services out to existing private clinics, Canada’s public health-care system can potentially serve more patients (including those whose surgeries have been postponed) without having to invest in expensive infrastructure. Second, by allowing patients to pay for treatment privately, the private sector can act as a pressure-valve and potentially alleviate stress on the public system. Third, an independent private sector won’t directly compete with other social programs or be bound by government budgets.

While these desperate times may very well call for desperate measures (including the pause on elective surgeries), there remains the important—if uncomfortable question—of what happens next. Specifically, how do we address the surgery backlog?

Will patients simply be added to already long waiting lists? Or will governments consider policy reforms with an eye on patients whose surgeries have been cancelled due to COVID-19 and those Canadians who routinely face long wait times?