Waitlist Deaths in Ontario Demand Solutions

With Ontario politicians talking about patients dying on waiting lists, think tank SecondStreet.org shared statistics today on patients who have died on surgical and diagnostic scan waiting lists. Since 2019-20, at least 44,753 patients have died on waiting lists in the country’s largest province.

 SecondStreet.org has been gathering government data across Canada on patients dying on waiting lists. The figures include everything from heart surgery to hip operations to cancer care and everything in between.

“It’s positive that we’re seeing politicians talking about Canada’s broken health care system,” said SecondStreet.org President Colin Craig. “But we also need to hear politicians commit to reform if we’re going to see the situation improve. Politicians have spent decades throwing money at the problem and hoping things would improve. That clearly hasn’t worked.”

Ontario Health data, obtained by Freedom of Information requests, shows the following waiting list deaths by fiscal year for surgical and diagnostic procedures:

 2019-202020-212021-222022-232023-24
Surgical 986 1,096 1,417 2,096 1,935
Diagnostic 5,5346,941 7,397  9,404 7,947
TOTAL: 6,5208,037 8,814  11,500 9,882

Click on each fiscal year above to see the actual Ontario Health FOI response

“We’re seeing some positive health reform changes in Ontario, but we need to see a lot more,” said Harrison Fleming, Legislative and Policy Director at SecondStreet,org. “Public-private partnerships to deliver health care is one of those positive changes – although it’s not enough. The next Ontario government would be wise to copy what’s working in European countries that deliver better health care and shorter wait lists.”

Four solutions that parties could adopt to reduce waiting list deaths include:

  • Analyze and disclose how many patients died the previous year because the government took too long to provide treatment. This will help identify problem areas in the system and improve accountability.
  • Similar to Quebec and European countries, utilize “activity-based funding” to incentivize the health care system to deliver more services.
  • Copy the European Union by giving patients the right to be reimbursed for surgery in other countries. (the EU policy covers up to the same amount a home country would spend to provide treatment locally).
  • Continue to contract non-profit and other non-government clinics to provide services to patients in the public system. 
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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.