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Waiting lists unnecessarily long

“It really upsets me I can’t cuddle my grandchildren or pick them up or look after them even for half an hour … because I can’t chase after them, I can’t move fast.” 

Jenny Mckenzie, a retired senior citizen from Vancouver, shared those troubling comments with SecondStreet.org recently when we met with her to discuss her hip problems. It was hard to not get a lump in our throats when we heard her describe living in debilitating pain while waiting for an operation.

Sadly, Jenny is one of thousands of Canadians who are stuck on a waiting list and suffering. Studies suggest it doesn’t have to be this way. There are much better universal health care systems out there, which Canada could copy, without breaking the bank financially.

Before her severe hip troubles began last May, Jenny led an active lifestyle. She watched what she ate, visited the gym regularly and enjoyed walking to stay active. She had spent years working and paying taxes to support the Canadian health care system and now that it was her turn to rely on the health care system, the system let her down.

After going for a walk with a friend, Jenny began to experience severe pain in her hip. She then spoke with her doctor and was assessed by the government, scoring just 11 out of 48 (meaning her situation is quite serious).

Incredibly, Jenny was told at one point that she would have to wait until 2020 for surgery. After some persistent phone calls she’s now looking at potentially getting in by August – meaning a year on crutches and confinement to her apartment. No one would want a loved one to go through what Jenny is experiencing.

When stories such as these come to light, some say the solution is for the government to simply spend more money. But the numbers suggest money isn’t the problem.

Back in 1993, provincial government spending on health care averaged
$1,687 per person. This year the Canadian Institute for Health Information expects per person spending will reach $4,397 per person – far more than inflation.

Despite this large increase in spending, the Fraser Institute has calculated that health care waiting lists have more than doubled during this period – from
9.3 weeks to 19.8 weeks.

Part of the problem can likely be attributed to an aging population, but studies suggest we have a structural problem here in Canada.

The Commonwealth Fund, a progressive health care research body in the U.S., put out a report in 2017 that examined health care systems in 11 wealthy countries – including Canada and the U.S.

Canada ranked 9th while the U.S. came in 11
th (notably, we came in last place when it came to wait times). Clearly, Canada should not be looking to copy the U.S. health care model – and vice versa.

The United Kingdom, Australia, the Netherlands, Norway and New Zealand led the pack – and all five countries had shorter wait times. With the exception of the Netherlands, their health care systems all cost less than Canada’s.

The big takeaway is that if Canadian politicians want to provide faster care for patients like Jenny, they would be wise to spend less time throwing money at the problem and more time looking at health care models from Europe and down under.

Colin Craig is the President of SecondStreet.org
This column was published in Sun newspapers (Toronto, Ottawa, Winnipeg, Edmonton and Calgary) on February 25, 2019

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Prevention – reduce demand in the first place

If Canadians lived healthier lives, we could reduce demand for emergency services, orthopaedic surgeries, primary care and more. 

For instance, if you visit the Canadian Cancer Society’s website, you’ll read that “about four in ten” cancer cases are preventable. The Heart and Stroke Foundation notes that “almost 80 percent of premature heart disease and stroke can be prevented through healthy behaviours.” A similar number of Diabetes cases are also preventable. 

Many joint replacements and visits to ERs and walk-in clinics could also be avoided through healthy living. 

To be sure, not all health problems can be avoided through healthy living – everyday the system treats Canadians with genetic conditions, helps those injured in unavoidable accidents and more.  

But there is an opportunity to reduce pressure on the health care system through Canadians shifting to healthier lifestyles – better diets, more exercise, etc. 

To learn more, watch our Health Reform Now documentary (scroll up) or see this column. 

Partner with non-profits and for-profit clinics

European countries will partner with anyone who can help patients. 

It doesn’t matter if it’s a non-profit, a government entity or a private clinic. What matters is that patients receive quality treatment, in a timely manner and for a competitive price.  

In Canada, governments often delivery services using government-run hospitals instead of seeing if non-profit or private clinics could deliver the services more effectively. 

When governments have partnered with non-profit and private clinics, the results have often been quite good – Saskatchewan, Ontario and British Columbia are just a few examples of where partnerships have worked well. 

Canada should pursue more of these partnerships to reduce wait times and increase the volume of services provided to patients.  

To learn more, watch our Health Reform Now documentary (scroll up) or see the links above. 

Make cross border care more accessible

In Canada, citizens pay high taxes each year and we’re promised universal health care services in return. The problem is, wait times are often extremely long in our health system – sometimes patients have to wait years to see a specialist or receive surgery. 

If patients don’t want to wait long periods, they often have to reach into their own pocket and pay for treatment outside the province or country. 

Throughout the European Union, we also find universal health care systems. But a key difference is that EU patients have the right to go to other EU countries, pay for surgery and then be reimbursed by their home government. Reimbursements cover up to what the patient’s home government would have spent to provide the treatment locally. 

If Canada copied this approach, a patient waiting a year to get their hip operation could instead receive treatment next week in one of thousands of surgical clinics throughout the developed world. 

Governments benefit too as the patient is now back on their feet and avoiding complications that sometimes come with long wait times – meaning the government doesn’t have to treat those complications on top of the initial health problem. 

To learn more, watch our Health Reform Now documentary (scroll up) or this shorter video. 

Legalize access to non-government providers

Canada is the only country in the world that puts up barriers, or outright bans patients from paying for health services locally. 

For instance, a patient in Toronto cannot pay for a hip operation at a private clinic in Toronto. Their only option is to wait for the government to eventually provide treatment or leave the province and pay elsewhere. 

Countries with better-performing universal health care systems do not have such bans. They allow patients a choice – use the public system or pay privately for treatment. Sweden, France, Australia and more – they all allow choice. 

Why? One reason is that allowing choice means some patients will decide to pay privately. This takes pressure off the public system. For instance, in Sweden, 87% of patients use the public system, but 13% purchase private health insurance. 

Ultimately, more choice improves access for patients. 

To learn more, watch our Health Reform Now documentary (scroll up) or watch this short clip on this topic. 

Shift to funding services for patients, not bureaucracies

In Canada, most hospitals receive a cheque from the government each year and are then asked to do their best to help patients. This approach is known as “block funding”. 

Under this model, a patient walking in the door represents a drain on the hospital’s budget. Over the course of a year, hospital administrators have to make sure the budget stretches out so services are rationed. This is why you might have to wait until next year or the year after for a hip operation, knee operation, etc. 

In better-performing universal health systems, they take the opposite approach – hospitals receive money from the government each time they help a patient. If a hospital completes a knee operation, it might receive, say, $10,000. If it completes a knee operation on another patient, it receives another $10,000. 

This model incentivizes hospitals to help more patients – to help more patients with knee operations, cataract surgery, etc. This approach also incentivizes hospitals to spend money on expenses that help patients (e.g. more doctors, nurses, equipment, etc.) rather than using the money on expenses that don’t help patients (e.g. more admin staff). 

To learn more about this policy option, please watch our Health Reform Now documentary (scroll up) or see this post by MEI.