Waiting Time Problem in the Canadian Health Care System
For decades, long wait times have plagued the Canadian health care system, causing significant human and economic costs to patients, their families, and the economy as a whole. In 2004, the government enacted the Health Accord to strengthen the system by addressing long wait times in specific medical procedures (Canadian Institute for Health Information [CIHI], 2015). While the accord has caused marked improvements in the overall reduction of wait times, some gaps and challenges remain in certain areas such as consultation with specialists, diagnostic imaging, and surgeries (CIHI, 2015). The result is an unnecessary pain, mental distress, health deterioration and substantial medical costs (Wait Time Alliance [WTA], 2014). Traditionally, the government has increased lump-sum funding to provincial healthcare institutions in a bid to increase their capacity to handle more patients. While innovative in their conception, such initiatives failed given the endemic structural inefficiencies that riddle the entire system. Alternatively, Canada can adopt policies such as wait time guarantees and prioritization that have successfully worked in other developed countries such as Netherlands, England, and Denmark.
Recent statistics indicate a relatively stable trend in wait times while recording an increase in the number of patients receiving care (CIHI, 2015). The small progress in wait time reduction since 2012 is worrisome because it highlights the dire conditions that patients still face when accessing care. In 2015, the median wait between referral by a general practitioner and the receipt of treatment was 18.3 weeks, a 0.1 increase from 2014 (Barua, 2015). Besides, the median wait times for various technologies such as ultrasound, magnetic resonance imaging (MRI), and computed tomography (CT) were 4.0, 10.4, and 4.0 weeks respectively (Barua, 2015). While some provinces such as Newfoundland and Saskatchewan showed remarkable and sustained efforts to reduce wait time benchmarks, the others displayed either negligible or worsening trends (WTA, 2014). One of the reasons for the dismal performances by some provinces is their distance from big hospitals in the main cities. According to CIHI (2015), nearly 95% of the geographical expanse of Canada is considered rural and, therefore, contain inadequate medical facilities that cannot adequately address emergency conditions or specialty services. Patients endure long distances to a rural health facility or regional referral center for initial visits. The wait times are even longer for those transferred to urban hospitals for treatment.
Other causes of longer wait times include poor organization of services, shortage of healthcare practitioners, the absence of adequate long-term care facilities, and significant budget cuts to essential hospital services (Canadian Health Coalition, n.d.). Inefficiencies arising from the poor planning of medical services and the lack of proper coordination among healthcare workers eventually slow down service delivery due to the interdependence between the various hospital departments. Furthermore, most physicians work independently in private offices where they manage the appointment and treatment database of their patients separately. The lack of teamwork makes integration of patient records a hurdle because the data must be collected from the relevant offices for compilation and comprehensive decision-making (Canadian Health Coalition, n.d.). This lengthy process exacerbates the wait time problem. Personnel shortages imply that the number of patients far outweigh the number of practitioners, hindering timely access to care. As a result, most patients turn to emergency rooms for treatment, causing further delays. Canada also suffers from insufficient long-term care facilities that are necessary for catering to the needs of the ballooning aging population (Canadian Health Coalition, n.d.). The elderly suffer from illnesses such as Alzheimer’s disease and dementia that require regular check-ups but are usually non-critical with continued medical treatment. The existence of few long-term facilities means long intervals between checkups leading to a surge in avertible hospitalization and emergency room visits, which cause a shortage of beds and long wait times.
Long wait times produces several disastrous effects on both the patients and the country. First, the health of patients deteriorates and sometimes result in death, especially for those suffering from degenerative diseases such as cancer. In other cases, the worsening of certain ailments may cause medical complications that require more invasive procedures, thereby inflicting more pain. Patients also endure mental anguish and pain resulting from their illnesses. This mental torture extends to the families, who watch their loved ones suffer while they can do nothing. For children, long wait times can hamper normal physical development, leading to deformities. For instance, longer delays in treating children with neurological diseases such as muscle imbalance have a positive correlation with permanent skeletal malformations (Globerman, 2013). A study conducted by Blair (2008) found that the national 10-year action plan enacted by the Canadian government to create the wait time benchmarks for health care implicitly ignored children in the investigation (Globerman, 2013). Furthermore, the waiting periods for at least each child was longer than the maximum wait time limits set for various procedures. In another study, more than 25% of the children suffering from cancer received treatments beyond the maximum wait time caps, with cardiac surgery and neurosurgery showing the worst delays (Globerman, 2013). An escalation of child deformities has serious labor implications for the country when the children attain the majority age. The human cost of long waiting periods also worsens through the higher risk of medical errors. A study conducted in 2011 in Ontario emergency rooms divulged that discharged patients who presented during longer waiting times had an increased danger of dying within seven days after their visits to the doctor or after admission to the hospital (Globerman, 2013). Thus, the longer the waiting time, the greater the risk of death. The study attributed the magnified risk to the higher probability of medical errors resulting from poor decision-making by healthcare workers. Longer queues in ERs resulting from stressed systems cause practitioners to rush tests and shorten consultations to free up more space for other patients (Globerman, 2013). Consequently, they may miss certain symptoms or make wrong diagnoses that could kill patients.
Second, long wait times have serious economic costs implications. For the patients, the deterioration of their health due to delays means longer recovery periods that erodes their savings where no insurance exists, and hampers their income-earning capacity during the periods of inactivity (WTA, 2014). Additional costs include increased spending on palliative interventions such as pain management through antibiotics and treatments to stabilize patients while waiting for scheduled procedures. In the end, the country incurs losses in the form of flagging labor productivity and tax revenues. In 2004, the estimated tax revenue loss suffered by Canada in 2014 was $16.9 billion and was linked to five medical procedures including MRIs, cataract surgery, hip and knee replacement, and CABG surgery (WTA, 2014).
Compared to other developed countries, Canada still lags behind in providing quality care due to the longer wait times. In a survey measuring the perceptions of Canadians towards wait times, 27% of respondents reported waiting more than 4 hours in emergency rooms compared to only 1% in the Netherlands and 5% in the United Kingdom (WTA, 2014). Such countries have managed to reduce their wait times significantly by implementing a combination of strategies to address the whole healthcare system. By identifying what worked in these countries and adopting them, the Canadian government can reduce and possibly eliminate the wait time issues. First, it can enact a charter on the rights and responsibilities of both patients and practitioners to guide healthcare provision in the country. The charter should guarantee certain matters such as the ability of patients to choose their providers and switch them at will, enforcing maximum caps for the wait times, and rewarding providers who manage more patients in a timely manner (Globerman, 2013). For instance, Finland enacted the National Health Care Guarantee in 2005 to address longer waiting times (Siciliani, Moran & Borowitz, 2014). According to the policy, the maximum wait time for elective procedures was three months. Providers who failed to meet the targets were penalized by the Supervisory Agency and could be liable for fines. The result was a substantial decline in wait time. In England, multiple targets exist for a variety of treatments and surgeries. For instance, the maximum wait for the initial outpatient appointments is 13 weeks, while that of inpatient treatment is six months (Willcox et al., 2007). In 2008, the wait time limit for the period between referral to admission and treatment was set at 18 weeks.
Second, a shift from lump-sum funding to activity-based funding in hospitals will ensure that finances only flow to productive areas. Hospitals that treat more patients can receive more funding while physicians receive bonuses. The Netherlands switched from fixed budgeting system to activity-based payments to both specialists and providers in 2008. It combined paying for activity with paying for wait time reduction to achieve maximum benefits. As a result, the country has the lowest waiting periods globally of less than one and a half months (Siciliani, Moran & Borowitz, 2014). Third, Canada can expand the capacity of existing facilities by increasing public spending, hiring more physicians and other health workers, and purchasing more acute care beds to cater for the rising number of patients visiting the hospitals. Denmark used this strategy in the early 1990s upon anticipating a surge in demand for coronary vascularization (Kreindler, 2010). It increased the equipment, staff, and operating rooms in major hospitals leading a marked fall in wait times.
Fourth, the government can ration healthcare services through prioritization. This policy ensures that patients with severe illnesses receive treatment first. The assumption is that the strategy will reduce the risk of medical harm while assigning less critical patients to other non-specialty physicians to ease congestion in emergency rooms (Globerman, 2013). New Zealand is the only country known to have successfully used rationing to reduce waiting periods. It introduced prioritization paired with specified treatment thresholds and wait time targets in certain surgical procedures. This policy guaranteed critical patients access to surgery within six months while non-critical ones were added to the waiting lists and referred to their physicians for regular monitoring (Globerman, 2013). This move eliminated unnecessary hospitalization, thus freeing up more space for other patients.
In conclusion, longer waiting periods in healthcare facilities are detrimental to the survival of patients and the country as a whole. Patients endure pain, mental anguish, income loss, deformities, and in some cases death. On the other hand, the economy loses substantial tax revenues due to the loss of labor productivity. While Canada has seen marginal reductions in wait times over the years, more effort is necessary to eliminate the problem. Emulating the strategies of other countries such as activity-based funding, increasing capacity, patient guarantees, and prioritization can help shorten the wait times in the Canadian healthcare system. If successful, the country will join the rank of other developed countries such as Netherlands, Denmark, and the UK while offering universal care to its citizens.
References
Barua, B. (2015). Waiting your turn: Wait times for health care in Canada, 2015 Report. Retrieved from Fraiser Institute website: https://www.fraserinstitute.org/sites/default/files/waiting-your-turn-2015.pdf
Canadian Health Coalition. (n.d.). Wait Times: Causes and Cures. Retrieved March 14, 2016, from http://medicare.ca/main/the-facts/wait-times-causes-and-cures
Canadian Institute for Health Information (CIHI). (2015). Wait Times for Priority Procedures in Canada, 2015. Retrieved from https://secure.cihi.ca/free_products/2015%20Wait%20Time%20Report%20VP%20Approved_EN.pdf
Globerman, S. (2013). Wait Times for Health Care: What Canada Can Learn from Theory and International Experience. Retrieved from https://www.fraserinstitute.org/sites/default/files/reducing-wait-times-for-health-care.pdf
Kreindler, S. A. (2010). Policy strategies to reduce waits for elective care: a synthesis of international evidence. British Medical Bulletin, 95(1), 7-32. Retrieved from http://bmb.oxfordjournals.org/content/95/1/7.full
Siciliani, L., Moran, V., & Borowitz, M. (2014). Measuring and comparing health care waiting times in OECD countries. Health Policy, 118(3), 292-303. Retrieved from http://www.healthpolicyjrnl.com/article/S0168-8510(14)00226-7/pdf
Wait Time Alliance (WTA). (2014). Time to close the gap: Report card on wait times in Canada. Retrieved from http://www.waittimealliance.ca/wp-content/uploads/2014/06/FINAL-EN-WTA-Report-Card.pdf
Willcox, S., Seddon, M., Dunn, S., Edwards, R. T., Pearse, J., & Tu, J. V. (2007). Measuring and Reducing Waiting Times: A Cross-National Comparison of Strategies. Health Affairs, 26(4), 1078-1087. Retrieved from http://content.healthaffairs.org/content/26/4/1078.full.pdf
