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What went up isn’t coming down
By Nadeem Esmail
 Waiting
for health care in Canada has, sadly, become a regular part of the Medicare experience. While many may hope that all of the
provincial and federal attention to the issue (and the resulting new initiatives) will produce positive results, others have come to
realize that wait times for medically necessary treatment cannot be resolved without substantive reform to the Medicare program.
While things might get better in those areas where attention is focused, the prospects for improvement overall are limited under the
structure of Medicare we have today.
In late October, The Fraser Institute released the 16th edition of Waiting Your Turn: Hospital Waiting Lists in Canada;
Canada’s only national, comprehensive, and comparable measurement of waiting times for medically necessary services. The report
found among other things that the overall median wait time for treatment in Canada (averaged across 12 medical specialties and 10 provinces)
increased slightly in 2006 reaching 17.8 weeks from GP referral to treatment by a specialist. That wait time is the second longest
ever experienced (the longest was 17.9 weeks in 2004), and not far from double the wait time experienced back in 1993 (9.3 weeks).
While wait times were worse in 2006 for patients overall, they actually improved in terms of the wait to receive treatment
by a specialist. Specifically, the wait time from specialist to treatment for the average Canadian fell to 9.0 weeks in total,
0.4 weeks less than in 2005. However, the improvement in this segment of total waiting time—it is in this segment that most Canadian
improvement efforts are focused—was more than offset by a 0.5 week deterioration in the wait time from GP referral to appointment with a
specialist.
Though the total wait time (GP to treatment) was longer in 2006 than 2005 for Canada as a whole, Alberta, Ontario, and Newfoundland
actually saw a reduction in the total wait for medically necessary care. On the other hand, wait times in the other seven provinces
deteriorated despite numerous commitments by Canada’s provincial and federal governments and record levels of health spending across
Canada. The disconnect between health spending and wait times evidenced by these differing experiences should come as no surprise.
Analyses of wait times and health spending have previously revealed that provinces spending more on health care per person do not
have shorter weighted median waiting times than provinces spending less.
A quick analysis of health spending estimates from the Canadian Institute for Health Information for 2006-07 and wait times
in 2006 illustrates the point. While Ontario ranked first in total waiting time in 2006, the provincial government’s health expenditures
per capita are expected to rank 8th in 2006-07. Alberta, second ranked for wait times in 2006, is expected to rank first in spending
for 2006-07. At the other end of the spectrum, Saskatchewan (ranked 9th among the provinces for total waiting time) is expected to rank
third in health expenditures in 2006-07.
Put simply, Canadians should not expect significant relief from wait times in the near future as a result of increases in health
spending and new provincial programs measuring and managing queues for treatment. Long wait times for medically necessary treatment in
Canada are a symptom of a much greater problem: a poorly designed health care system.
Canadians should also not be celebrating Ontario’s top-ranking performance. While a wait time of 14.9 weeks is better than that in all
other provinces, it is well short of the international gold standard. Patients in Austria, Belgium, France, Germany, Japan, Luxembourg,
and Switzerland receive their health care (regardless of ability to pay) with virtually no waiting times at all. By that standard, all of
Canada’s provinces are failing Canadians, and have been for many years. Notably, Canadians experience some of the longest waiting times in
the developed world.
Contrary to what some commentators might suggest, Canada’s failure relative to the gold standard is not the result of a lack of
health expenditures. In fact, Canada spent more (age adjusted) than 25 of the 28 world’s most developed nations that have a universal
access health care system in the most recent year for which comparable data is available – only Switzerland and Iceland spent more.
What becomes clear when examining Canada’s wait time record and the performance of the developed world’s most successful
universal-access health care programs is that Canada’s program suffers from a lack of private competition (in both finance and delivery)
and appropriate financial incentives for both patients and providers. The predictable result is a very poor performance on access to care
coupled with some of the highest health care expenditures in the developed world.
It is time that Canadians sat down and took an honest look at what works elsewhere in the developed world. Improving the state of
health care in Canada, where Canadians pay for world class health care and receive anything but in terms of access, will require
moving beyond the politics, rhetoric, and nonsense that have plagued discussions of health care reform for many years. Not doing
so will only continue to condemn Canadians to an expensive and sub-standard health care program.
Nadeem Esmail is a Director of Health System Performance Studies for the Fraser Institute.
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