Pain and Suffering, Guaranteed

On Monday, Canada’s provincial and federal governments released their “comparable wait time benchmarks,” which will help guide provincial wait time reduction plans that should be released by the end of 2007. What is most notable about these benchmarks, besides the fact that they are not actual commitments or guarantees, is that they are in many cases longer than what Canada’s physicians think are appropriate. More alarming is the fact that the provinces are paying almost no attention to what is really possible.

According to a survey of Canada’s medical specialists, a clinically reasonable wait time for a hip or knee replacement is about 12 weeks. Canada’s provinces have determined that 26 weeks is a good ‘benchmark’.

The provinces have also determined that priority level I, II, and III patients in need of bypass surgery should wait no longer than 2 weeks, 6 weeks, and 26 weeks respectively. Canada’s physicians, on the other hand feel, that patients in need of cardiac bypass surgery should wait no longer than between 0.5 and 2 weeks for urgent surgery, and between 4 and 8 weeks for elective surgery.

Clearly, there is a big disparity between the ‘benchmarks’ determined by the provinces and the professional opinions of Canada’s physicians.

What is being quickly forgotten in Canada, however, is that any wait for care involves pain and suffering, lost productivity at work and leisure, mental anguish, and additional strain on personal relationships. The best wait time for patients is not the one that minimizes medical harm, but the one that minimizes waiting altogether. A truly patient-focused health care system, one that is truly deserving of the title ‘world class’, is one that delivers care without systemic delay.

Canadians might be amazed to learn that there are seven universal access health care programs in the developed world that deliver this sort of access to care. Austria, Belgium, France, Germany, Japan, Luxembourg, and Switzerland all guarantee access to care regardless of ability to pay. But unlike Canada these countries provide universal access to care without any delay. Further, the cost of these health care programs is, on an age-adjusted basis, similar to or less than what Canadians spend on health care so it is not more funding that has achieved these remarkable results.

Rather, this admirable performance comes from a commitment to health care models that rely on competition and appropriate incentives. Unlike Canada’s Medicare each of these nations relies on private competition in the hospital care sector, on user fees for medically necessary services, and on a parallel private health care sector to ensure that patients of all incomes get access to the very best care in a timely fashion.

Such policies lead patients to make more informed decisions when seeking care and give providers the incentive to deliver more health services at higher quality and more efficiently than they would otherwise.

And therein lies the real solution to Canada’s wait time problem. Rather than pursuing management programs, big wait list registries, and ‘benchmarks’, the provinces should be following the guidance of the world’s leading health care programs and focusing on what is best for the patient.

Of course, that would mean abandoning the status quo, which clearly does not work, and moving instead to a set of guiding health policies that are based on sound economic principles and which have proven to be immensely successful in other developed nations’ universal health care systems.

While our provinces and federal government should be applauded for acknowledging there is a problem and actually attempting to do something about it, they are falling well short of the gold standard.

First, their own ‘benchmarks’ are substantially longer than what Canada’s own physicians think reasonable.

But more importantly, all of their actions are based on the premise that Canadians must wait for care and will always wait for care. International evidence and experience suggests that such a fundamental belief is flawed: it is possible to give patients excellent access, on their own terms, to a responsive, efficient, and high quality health care program. But doing so will require an informed and honest debate about what works, rather than a blind commitment to managing what doesn’t.