Non-COVID patients pay price for health-care backlogs

Last week, COVID-19 claimed another life—Rosine Chouinard-Chauveau, a 28-year-old actress in Montreal. However, her name will likely not be counted among COVID mortality numbers because she did not die from the virus. Rather, she died waiting for surgery for an undisclosed health issue. According to a statement from Chouinard-Chauveau’s family, the surgery “could not take place on time due to the délestage in the health system to handle the pandemic.”

While many Canadians may be unfamiliar with the term, they’ll understand the concept. Délestage, in this context, refers to the cancelation or postponement of surgery and other medical treatments in anticipation of COVID caseloads. According to the Quebec government, an estimated 140,000 patients are waiting for surgery in the province, with nearly 44,000 having already waited more than six months.

To be clear, Quebec’s backlog is not unique to the province. In fact, across Canada, provincial health ministers made the difficult decision to cancel thousands of elective surgeries to ensure our scarce medical resources would be available for new COVID cases. The good news is provinces such as British Columbia have significantly reduced their COVID-related backlogs by increasing surgical capacity, partnering with private clinics and hiring new staff. However, despite the progress, B.C.’s government still reported 88,401 patients waiting for treatment in Nov 2020.

So what’s going on?

While COVID-19 has exacerbated challenges in the health-care system, Canada has been rationing care for years. In fact, according to estimates published by the Fraser Institute, more than one million patients endured waited a median wait of 20.9 weeks for medically necessary elective care in 2019—long before COVID. Sadly, as families across the country know too well, these wait times can have serious consequences. Some patients may be in pain or unable to work while those less fortunate may experience a permanent deterioration of an otherwise treatable condition. And in the worst cases, patients may pay the ultimate price. A recent report suggests that at least 1,480 (and maybe as many as 3,841) surgeries were cancelled in 2018-19 because the patient died while waiting for care. And remember, that’s in the pre-COVID world.

Moreover, doctors across Canada increasingly indicate our current délestage approach to health care is extending beyond “elective” treatments (hip surgery, for example) to more critical areas such as cancer care and cardiovascular surgery where delays can be fatal. And when Canadians seek private alternatives within our borders, they run into provincial restrictions. In fact, Canada’s unique and restrictive approach to universal health care stands in stark contrast to other, arguably better-performing, universal health-care countries.

And just to be clear, today’s surgical backlogs (and other problems with Canada’s health-care system) are not the result of inadequate funding. Canada ranks among the most expensive universal health-care systems in the world yet has fewer physicians, beds and diagnostic imaging scanners (such as MRI machines and CT scanners) than comparable universal health-care countries such as Switzerland, the Netherlands, Germany and Australia. And of course, we also have some of the longest wait times.

Our health-care workers have done an incredible job during this pandemic, and in the absence of long-term data, health-care officials had to make difficult choices in anticipation of COVID-19’s potential impact. But as the cost of these decisions adds up, and with new COVID-19 variants on the horizon, we may need to reassess the costs and benefits of our current approach to better optimize care for all Canadians—not just COVID patients. Or at least allow Canadians to access private alternatives. Not only would this help those specific patients, but it would also potentially reduce the strain on our overburdened public system.

Rosine Chouinard-Chauveau’s tragic story has shone a new light on an old problem; one that has been exacerbated, but not caused, by COVID-19. While it will take significant reform to address the routine rationing of care in our health-care system, governments across Canada can no longer ignore the many non-COVID patients who’ve paid a heavy price since the pandemic began.