SUN NEWS COLUMN: Waiting List Deaths More Common Than We Think

In 2019, 72-year-old Quebec patient Michel Houle was told he needed heart surgery within two to three months.

Houle lasted five months on a government waiting list, but sadly he passed away. A few months after his death the government finally phoned him to schedule his surgery.

Tragic stories like this led SecondStreet.org to conduct some ground-breaking research into just how many Canadians die while waiting for surgery each year.

We wanted to know if stories like Houle’s are a rare occurrence – as some claim – or if they’re more common than we think.

SecondStreet.org asked 50 hospitals and health regions in Canada for data on the number of surgeries during the 2018-19 fiscal year that were cancelled as the patient had passed away.

Most hospitals and health regions told us they simply don’t track data on patient deaths while waiting for surgery. Overall, the data was quite atrocious, especially considering we’re talking about the well-being of patients.

21 hospitals and health regions did respond to our requests with varying amounts of data, however. Their records showed 1,480 patients died while waiting for surgery in 2018-19. However, as those health bodies represent less than half of Canada’s population, the true figure is likely closer to 4,000.

The data provided to SecondStreet.org showed that patients were waiting for a variety of procedures when they passed away. Some were waiting for potentially life-saving procedures (eg. heart operations) while others were waiting for procedures that could have improved their quality of life (eg. hip operations).

The data showed patients had been waiting anywhere from less than a month when they passed away to more than eight years. In many cases, patients waited longer than the medically recommended time period. For instance, 65 per cent of the patients who passed away while waiting for surgery in Nova Scotia had been waiting longer than the recommended period.

Just imagine spending your final few years living in pain or being confined to your home.

As our data is from a period before COVID, one could reasonably assume these numbers have only gotten worse; after the pandemic hit Canada, governments postponed thousands of procedures as part of efforts to “prevent the spread.”

Addressing Canada’s surgical backlog is a complex topic, but two solutions we identified, include:

First, governments could vastly improve the data they track and disclose when it comes to patient suffering in the health care system. It’s quite astounding that governments make businesses file reports on minor workplace accidents that result in employees receiving so much as a bruise. Yet, at the same time most governments don’t track, and certainly don’t proactively disclose, information on patients dying or suffering while waiting for surgery.

Doing so could help researchers learn more about patient suffering and could also help policy makers address problem areas.

Second, governments could stop forcing patients to languish on waiting lists, while also forbidding them from seeking treatment at private clinics. The government could keep our public health care system but allow private clinics to provide the same services – like every other developed country with waitlists that are shorter than Canada’s. This could ease the pressure on the public system while helping to improve patient health in Canada.

Clearly, stories of patients dying while waiting for surgery is well beyond anecdotal.

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

This column was published in Sun News Columns on December 20th, 2020. To see column 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.