WINNIPEG FREE PRESS COLUMN: Manitoba Could Improve Tracking And Disclosure On Waiting List Deaths

SecondStreet.org waiting lists Canada

New data obtained by SecondStreet.org shows eight patients died in Manitoba while waiting for heart surgery over a recent two-year period.

The data is incomplete, but the research endeavour demonstrates that the Manitoba government could improve how it tracks and discloses information on patient suffering.

As it stands right now, the government discloses more information when it shuts down a pizza restaurant than what it does after a patient dies while waiting for care.

SecondStreet.org began investigating the sad reality that some patients die while waiting for health care services after a 2019 news story from Manitoba. The news story indicated that patients were waiting upwards of 70 weeks for an echocardiogram.

Next door in Saskatchewan, patients only had to wait a week for an echocardiogram.

The story led to SecondStreet.org filing Freedom of Information requests nation-wide to learn more about patients dying while waiting for surgeries, diagnostic scans and appointments with specialists.

Government data obtained through that research showed over 11,400 waiting list deaths between April 1, 2018 and December 31, 2020. However, this is a low-balled figure as many jurisdictions simply don’t track the data.

The data that health bodies provided was often incomplete (some hospitals provided totals rather than a breakdown by procedure), but it appears the majority of patients died while waiting for surgeries which would have merely improved their quality of life (eg. cataract operations, hip surgery, etc.) rather than potentially saving their lives (eg. heart operations). In many cases, patients had been on government waiting lists for over a year.

In Manitoba, most health regions struggled with providing data. Only recently were we able to obtain Winnipeg Regional Health Authority data and even then it only covered one type of surgery – the aforementioned eight patients who died while waiting for cardiac surgery between April 2019 and April 2021. Two of the patients died after waiting more than 120 days for surgery – one of whom waited longer than the maximum recommended time period. For three of the patient deaths, there was no information on the maximum recommended wait time.

To be sure, it’s not clear if any of these patients died because they waited too long. But it is discouraging that the government doesn’t track many important pieces of data related to these cases or other surgeries, diagnostic scans and appointments with specialists.

The Manitoba government does, however, release “critical incident” reports when unintended events occur in the health care system that result in “serious or undesired” outcomes. Unfortunately, the reports lack detail. For example, in 2019 the government disclosed that over a three-month period there were 15 critical incidents that resulted in death. Here is an example of what was disclosed for one of the cases:

“There was a delay in recognition of acute changes to diagnostic information leading to a missed opportunity for earlier intervention.”

This tells readers and researchers very little about what happened.

How long was the delay? What was the acute change to diagnostic information? The short blurb suggests the patient died because of the mistake – was anyone held accountable? Which health facility was responsible? What changed as a result?

Conversely, consider what the government disclosed after it shut down the Wood Fired Pizza restaurant in Brandon for breaking a provincial government rule:

“Extensively remodel a food handling establishment without first registering.”

The government disclosed the name of the business, reason for shutting it down and readers can understand what occurred.

To be sure, patient health information requires confidentiality. But data can still be disclosed in such a way that more is known about patient suffering in the health care system. And if more information is gathered and published, policy makers and voters can focus on remedies, including health reform.

 

Colin Craig is the President of SecondStreet.org, a new Canadian think tank. He can be reached at colin@secondstreet.org

 This column was published by the Winnipeg Free Press on November 3, 2021.

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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.