LEADER POST: Dying For Health Reform

SecondStreet.org recently asked the Saskatchewan Health Authority, and 49 other health regions and hospitals in Canada a simple question – how many of your surgeries were cancelled in 2018-19 as the patient had passed away?

What sparked this research project were stories like Laura Hillier’s. The young Ontario teen made headlines in 2016 after her cry for help on social media went viral. During her courageous fight against cancer, she found herself waiting for surgery as the government had only rationed enough funding for five procedures per month.

Sadly, Laura passed away after a seven month wait for surgery. However, her story endures as an enormous neon sign over our nation that continues to flash: “health reform urgently needed.”

Several other stories like Laura’s caused us to ponder – how many patients are passing away each year in Canada while waiting for surgery? We also wondered how many patients spend their final years suffering while waiting for the government to provide surgeries that could improve their quality of life (eg. hip operations, cataract surgery, etc.)?

The majority of hospitals and health regions responded to our query by indicating they don’t track data on patients that die while waiting for surgery. It’s amazing that such a tragic outcome is not documented in our health care system, but then again, one can’t forget that government monopolies generally struggle with providing effective services.

Twenty-one hospitals and health regions did, however, provide us with at least some data. Combined, their figures show that 1,480 patients died while waiting for surgery during the 2018-19 fiscal year. Considering those health bodies cover less than half of Canada’s population, the true figure is likely closer to 4,000 deaths. 

As these cases occurred prior to COVID-19 one should not be surprised if these figures have risen this year. Don’t forget once the pandemic arrived, governments postponed thousands of surgeries.

Government data shows patients died while waiting for everything from potentially life-saving treatment (eg. heart operations) to procedures which could have affected a patient’s quality of life (eg. hip operations, cataract surgery, etc.). Patients died after waiting anywhere from less than a month for surgery to more than eight years. While we don’t know the stories behind the numbers provided to us, many of the figures give pause for concern.

For instance, in Saskatchewan, the government noted 242 patients died while waiting for surgery in 2018-19. Just over half of the procedures were for cataract surgery, but there were also many other procedures on the list – brain, bowel, prostate and urinary system surgery to name a few. The data suggests that approximately half of the province’s waiting lists deaths were cases that saw patients wait longer than the recommended wait time when they passed away.

In Nova Scotia, the government noted there were 25 deaths while patients waited for surgeries that could have potentially saved their lives. In “just over half” of the cases, patients had waited longer than the recommended maximum wait time. In Alberta, 67 per cent of the patients that died while waiting for surgery had passed away after waiting more than a year.

Addressing Canada’s surgical backlog is a complex topic, but one solution is to keep Canada’s public health care system but lift the ban on private clinics providing the same services. This would bring Canada in-line with other developed nations that enjoy both universal health care and shorter waitlists.
More health care choices would not only give patients an alternative to spending their final year(s) suffering or dying prematurely, private clinics would also take some of the pressure off of the public health care system.

Allowing private clinics to provide more services won’t solve all of our health care
system’s problems, but it would certainly give patients more treatment options. As the data shows, many patients could do with more choices.

Colin Craig is the President of SecondStreet.org, a new Canadian think tank. All of the government responses from this report can be viewed on our website.

This column was published in Leader-Post on December 11th, 2020. To see article click here. 

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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.