THE CHRONICLE HERALD: Hundreds Of Nova Scotians Dying Annually On Surgery Waitlists

Nothing is as critical nor deeply personal as our health. Yet Nova Scotians and all Canadians have little control over their own outcomes when surgery is required. New research from SecondStreet.org shows that in 2018-19 alone, nearly 400 Nova Scotians died waiting for surgery.

SecondStreet.org obtained data from provincial health departments, health regions and hospitals across Canada. The health bodies cover less than half of Canada’s population and their combined data showed 1,480 Canadians died waiting for surgery in 2018-19. Of the regions with reliable data, Nova Scotia had the highest per-capita number of people die waiting for surgery.

Sixty-five per cent of those 398 Nova Scotians died after waiting longer than the government’s target time. For 25 of the deaths, the delays in treatment “might reasonably be implicated causally.” In just over half of those cases, the patients died after waiting longer than the medically recommended time period.

Overall, Canadian patients waited anywhere from less than a month to more than eight years before they died. Patients died while waiting for procedures that could be linked to the cause of their death (eg. cardiac surgery) and procedures which could have increased their quality of life (eg. knee surgery).

The data were incomplete and reveal significant issues with reporting quality. Many health regions do not record why Canadians drop off surgery wait lists. For example, no data whatsoever was available in New Brunswick or Newfoundland and Labrador.

In Nova Scotia, the data was fairly comprehensive. For that, the government deserves credit. The numbers illuminate the problem.

In Canada, politicians decide between funding surgical procedures or letting patients spend more time on waitlists while the money is spent building football stadiums, bailing out corporations and countless other activities.

These political decisions have human costs. 

In Ontario, 18-year-old Laura Hillier died from cancer – despite having a bone marrow donor lined up – after waiting seven months for a surgeon to become available. The government had only allocated enough funds for five transplants per month and Laura was forced to wait. She released a public cry for help, afraid she would die before treatment.

In Quebec, 72-year-old Michael Houle spent five months on a waitlist before he died, despite requiring cardiac surgery within two to three months. A few months after his death, the government called to plan his surgery.

In Nova Scotia, the government may allot enough funds for, say, 200 hip replacements surgeries in a given year. Patient number 237 will simply need to wait.

That is, unless they can find the funds to pay for health services abroad. According to a 2019 SecondStreet.org policy brief, Canadians made over 217,500 trips to other countries specifically for health care in 2017.

Many other countries share Canada’s goal of universal access to health care regardless of ability to pay. But most systems offer both government and private health care options.

Of the 11 countries surveyed by the Commonwealth Fund in 2017, Canadians were the most likely to wait two months or more to see a specialist and four months or more for surgery.

The pandemic will likely only make this problem worse.

Maintaining Nova Scotia’s public health care system, but allowing private clinics to offer health services, could increase patient options and reduce pressure on the crowded government system.

Like the majority of Canadian provinces, Nova Scotia already allows private clinics to conduct MRI scans.

Additionally, a private medical clinic opened in Halifax in 2018, charging patients $35 to see a nurse practitioner. Another private online clinic allows Nova Scotians to connect with doctors virtually. Both address Nova Scotia’s 47,000-person family doctor waitlist.

There is much ado about expanding patient choice in Canada but despite each of these private options existing, the sky did not fall, Nova Scotia’s universal health care system still served patients and the government continued to increase health spending.

The data shows too many Nova Scotians are dying while waiting for surgery. Isn’t it time politicians considered giving patients more choice?

Paige MacPherson is a SecondStreet.org contributor and a policy and communications professional based in Halifax.

Share on Facebook
Share on Twitter

You can help us continue to research and tell stories about this issue by making a donation or sharing this content with your friends. Be sure to sign up for our updates too!

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.