TORONTO SUN COLUMN – Health care reform can shorten waiting lists and prevent deaths

The number of patients who died last year while waiting for surgery and diagnostic scans in Ontario was up significantly compared to past years, according to new data obtained exclusively by SecondStreet.org. While the numbers are specific to Ontario, it’s another example of why Canada needs health reform. 

Most readers will know that long health-care waiting lists can affect a patient’s quality of life; many live with chronic painsevere anxiety and lose income while they are unable to work. 

Even worse, long waiting periods can cost patients their lives. 

Judy Anderson, a retired nurse from Port Perry, Ont., described to SecondStreet.org how her daughter Shannon experienced heart trouble in late 2020. Despite having a treatable conditionShannon was left to languish on a waiting list. Eventually, her condition worsened, she said her goodbyes to loved ones and checked herself into a hospital. A few days later, she died, leaving behind four children. 

New data obtained by SecondStreet.org shows there were 2,096 patients who died while waiting for surgery in 2022-23. This is a 49% increase from the year before. To be clearthese patients were waiting for a wide array of surgeries — everything from cataract surgery to cardiac cases. It’s unlikely someone would die because they didn’t receive cataract surgery in time, but one shouldn’t dismiss such cases. Would you want to spend your final year or two with cloudy vision? 

Ontario health data also shows the number of patients who died while waiting for diagnostic scans has increased steadily from 1,341 in 2015-16 to 9,404 last year. 

Some politicians will throw these figures around and play the blame game, but readers should note that waiting-list deaths occur regularly across the country, regardless of the party in power. SecondStreet.org has tallied more than 50,000 waiting lists in Canada over the last five years. 

It’s difficult to pinpoint where in Canada the wait list suffering is the worst, but it would be helpful if every province recorded and disclosed data like Nova Scotia. Last year, the Atlantic province clearly noted that 28 patients died while waiting for procedures that could potentially have saved their lives. Of those, over “60%” had waited longer than the recommended wait time. 

In Ontario, Alberta and other parts of Canada, governments are partnering more and more with private clinics to provide services to patients. Just like visiting your family doctor’s office (which is also a private business), patients aren’t charged for surgery at these facilities — it’s paid for by governments using tax dollarsPartnering with private clinics is positive step that has been proven to help reduce wait times everywhere from Saskatchewan to Sweden. 

Another change that could help would be to let those who are willing and able to pay for services at local private clinics. As some patients choose this option, they’ll free up space on public waiting lists. Right now, except in Quebec, patients aren’t allowed to pay for surgery locally. This is why, for example, Vancouver patients travel to Calgary for private knee surgery and vice versa. It makes no sense. 

More and more patients are dying without receiving the care they need. Some provinces are making steps in the right direction, but more needs to be done.  

Colin Craig is the president of SecondStreet.org, a Canadian think tank 

This column was published in the Toronto Sun on August 17, 2023.

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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.