Reform could shorten Nova Scotia’s brutal health-care wait times

When the Houston government released its first budget last month, it placed much emphasis on health care. This was not surprising given the evidence of a system in strain. For example, new data reveal more than 27,000 patients are waiting for surgery in the province. While a portion of this surgical backlog is related to the COVID-19, Nova Scotia’s health-care system has struggled to provide timely elective care to Nova Scotians for years.

Consider that in 2019, the last year before the pandemic, the Fraser Institute’s annual survey of physicians found that patients in Nova Scotia faced a median 33.3 week wait between referral from a general practitioner and treatment—the third-longest wait time in Canada and about three months longer than the Canadian average. Wait times for some specialties were much longer. For example, the median wait for orthopedic treatment in 2019 was 70.4 weeks, the longest in the country.

And the overall median wait between a specialist appointment and treatment across 12 specialties in Nova Scotia has increased 163 per cent between 1999 and 2019, further evidence of a problem that long-precedes the pandemic.

Long wait times for medically necessary care are costly. While patients may be able to wait for treatment without experiencing adverse consequences, others might not be as lucky. Long wait times can increase suffering, erode quality of life and lead to disability and death.

There’s also an economic cost to waiting on these lengthy public queues due to lost productivity and the value of time spent in reduced physical capacity. In 2019, the estimated cost of waiting for medically necessary care in Nova Scotia, after a specialist appointment, was $134 million—and this is simply accounting for lost working hours, not leisure time or sleep.

In response, the Houston budget pledged an additional $413 million in health-care spending. However, is more money the answer?

Consider the 20-year period before COVID when the provincial government increased health-care spending by 78.5 per cent (after adjusting for inflation). The province’s Ministry of Health accounted for 39.8 per cent of all provincial government program spending in 1999 compared to 43.1 per cent in 2019.

Rather than ever-increased spending, Nova Scotians could benefit from the experiences of other provinces that sought to lower wait times.

For example, the Saskatchewan Surgical Initiative, which aimed to reduce that province’s lengthy waits for medically necessary care. A main component of the plan, launched in 2010, was a provincial partnership that publicly funded private surgical clinics. As a result, the highest median wait time in the country outside of Atlantic Canada (26.5 weeks in 2010) shrunk to the second shortest in 2014 (14.2 weeks). These private clinics were also able to deliver 34 types of procedures at a cheaper rate (26 per cent, on average) than their public-sector counterparts.

Indeed, Nova Scotia has made some limited advances in this direction by contracting certain elective surgeries to private clinics to tackle its backlog while creating more room in public hospitals. These efforts are expected to “take 500 children off the list who are waiting for elective procedures,” according to Nova Scotia’s Health Minister Michelle Thompson. Unfortunately, it’s yet to be determined if these partnerships will endure or expand enough to tackle the surgical backlog in a serious way.

While COVID has greatly impacted Canada’s health-care system, wait times have been growing for years. If policymakers in Nova Scotia want to improve the system for the benefit of Nova Scotian families, they should consider novel and bold proposals and not rely on the status quo.