second_street_canada_journalism_stories_people_politics_government_2
DONATE
Facebook-f Twitter Instagram Youtube
DONATE

Report

Hand held tally counter counting headcount of people in a queue

FINANCIAL POST COLUMN: Dying For Health Reform

SecondStreet.org recently asked 50 hospitals and health regions in Canada a simple question: how many surgeries did you cancel in 2018-19 because 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 because the government had only rationed enough funding for five procedures per month. Sadly, Laura passed away after a seven-month wait for surgery. 
 
Stories like Laura’s caused us to wonder: how many patients die each year in Canada while waiting for either life-saving surgery, like Laura’s, or surgery that could improve their quality of life (e.g., hip or knee replacements)? 
 
The majority of hospitals and health regions responded by simply noting they don’t track the data we sought. But 21 hospitals and health regions were able to provide us with at least some data (you can see all the responses at SecondStreet.org). Together they cover roughly 40 per cent of Canada’s population. Their numbers show that 1,480 patients died while waiting for surgery during the 2018-19 fiscal year. They died after waiting anywhere from less than a month to more than eight years. In Saskatchewan, 52 per cent of waiting-list deaths appear to have occurred after patients had waited longer than the recommended maximum wait time. 
 
The data are incomplete, so we cannot break out all 1,480 patient deaths by procedure type. A review of what detailed data we did receive suggests a large number of the waiting-list deaths were not cases like Laura Hillier’s of potentially life-saving procedures but rather were for operations that would “only” have improved the patient’s quality of life. For example, cataract surgery and knee and hip operations were procedures many patients were waiting for when they passed away. In Saskatchewan, approximately half of the 242 patient deaths were of people waiting for cataract surgery. 
 
We shouldn’t dismiss such cases as being “merely” about quality of life, however. Would you want to spend the final year or two of your life with obstructed vision or largely confined to your apartment because your hip pain made it too difficult for you to go out? 
 
Moreover, despite the preponderance of cataract cases Saskatchewan’s list also included more serious procedures – brain, bowel, prostate and urinary system surgery, to name a few. In Nova Scotia, the government’s data showed 398 waiting-list deaths – 65 per cent of which occurred past the target time for surgery. The government did note that there were no fewer than 25 cases of patients dying while waiting for surgery that could have potentially saved their lives. In “just over half” of those cases, the patients had waited longer than the recommended maximum wait time when they passed away.
 
As mentioned, these data were for 2018-19. It would only be reasonable to expect the numbers to be even worse this year as governments postponed thousands of procedures because of the pandemic. 
 
Fixing this problem probably won’t be easy. A good start would be for governments to improve how they both track and disclose data related to patient suffering in the health-care system. Governments require businesses to file reports on workplace accidents that result in the most minor of injuries. Yet they themselves don’t track, and certainly don’t proactively disclose, information on patients dying or suffering while waiting for surgery. 
 
A second obvious measure would be for governments to stop making waiting lists longer by blocking private clinics from providing the treatment patients need. Our health system can be public even with the participation of private clinics and medical offices – as in every other developed country with waitlists shorter than Canada’s. 
 
One thing should be clear, the data we uncovered suggests patient suffering is more common than it should be. 
 
Colin Craig is president of the think tank SecondStreet.org.
 
This column was published by the Financial Post on December 21, 2020.
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!

GET UPDATES
DONATE
Facebook-f Twitter Instagram Youtube

Get Updates

SUBSCRIBE

Sign-up and receive the latest news from SecondStreet.org

Donate now

DONATE

We are 100% funded by donations. With your help, we can tell even more Canadians’ stories!

© 2021 SecondStreet.org. All Rights Reserved

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.