As provincial premiers wrangle with the Trudeau government over their diminishing share of transfer payments for health care, Canadian patients are being increasingly forced into ever longer waiting lines for medically necessary treatment—many of them leaving the country for care they can’t get at home in what they and their physicians consider a “clinically reasonable” time.
It’s a pattern that now appears to be an inherent reality of health care in Canada, one that has exacerbated tensions not only between provincial and federal politicians, but between the professionals responsible for treating patients and their increasing legions of bureaucrats and paymasters.
Each year, Canada’s leading independent public policy/healthcare think tank (it accepts no government money), the BC-based Fraser Institute releases an update on the wait times faced by patients for non –emergency (but medically necessary) treatment for conditions that are still painful, possibly debilitating, and sometimes deadly.
Wait your turn
In Waiting Your Turn: Wait Times for Health Care in Canada, 2016, released in November, the study reported that median medical wait times across Canada for medically necessary elective procedures had risen to 20 weeks—the longest ever recorded—double the 9.3 weeks Canadians waited in 1993, 23 years ago. “Median” is the mid-point between the longest and shortest wait times recorded in the survey. And it refers to the total wait time a patient is referred by his or her family physician to a specialist, to when the patient ultimately receives treatment.
On the basis of its national surveys with physicians in 12 medical specialties, the report team, headed by Bacchus Barua, senior economist in Health Policy Studies at the Fraser Institute, Canadians are now waiting for nearly one million medically-necessary procedures beyond which their physicians consider “clinically reasonable” times.
Says Barua: “Long wait times aren’t simply minor inconveniences, they can result in increased suffering for patients, lost productivity at work, a decreased quality of life, and in the worst cases, disability or death.”
Where are the wait times worst?
The longest wait times for referrals by a family physician to consultation with a specialist have risen to 9.4 weeks (155 percent longer than in 1993), and the longest waits are in New Brunswick (21.5 weeks), the shortest in Ontario (7.2 weeks). The longest wait times, from consultation with a specialist to receiving actual treatment, are 10.6 weeks (88 percent longer than in 1993). The shortest specialist-to-treatment wait times are in Saskatchewan (7.9 weeks), the longest in Nova Scotia (17.7 weeks).
As for types of treatment needed—the longest median wait times nationally are for neurosurgery (46.9 weeks), the shortest, for medical oncology (cancer), 3.7 weeks.
What’s the solution?
The quickest answer usually given to the problem of wait lists is “more money.” But there are many powerful arguments extant that go well beyond money, and focus more on re-organization of systems and creation of a new set of incentives for better, more direct care. But that’s another story, and we’ll get to it in more depth in 2017.
Look beyond your borders
One immediate solution to painful and disruptive wait lists is being practiced by increasing numbers of
Canadians (at least 45,000 of them in 2015) who have ventured abroad for non-emergency medical care.
This number does not include the many thousands who receive unexpected emergency treatment while traveling out of the country, usually under private travel insurance as their provincial insurance covers less than 10 percent of foreign hospital and medical bills.
In a related report from the Fraser Institute released in October, 2016, an estimated 45,619 Canadians traveled abroad in 2015 to receive non-emergency (but medically-necessary) medical care—the greatest numbers for eye treatment, general surgery, internal medicine procedures such as colonoscopies, gastroscopies and angiographies. This number, cautions report author Barua, is almost certainly an underestimate as it reflects only those patients who were referred out by their own physicians, or who reported their out-of- country treatment to their home physician.
It does not count the many Canadians who went directly to foreign hospitals, predominantly American, who advertise their services to international clientele, or who were referred by friends or relatives—without involvement of their own physicians.
We should note, however, that some of the Canadian patients referred out of the country by their physicians may have their expenses covered, or subsidized, by their provincial health ministries if they apply for such referrals. Health ministries are now spending millions of dollars “exporting” such patients to mostly border-area hospitals in the US for treatments or procedures unavailable within reasonable time periods. Those costs, we will explore in forthcoming articles.
The greatest number of these medical expatriates were from Ontario (over 22,000), B.C. (over 10,000), and Alberta (over 4,600).
“Considering Canada’s long health-care wait times and their potential negative effects, it’s not surprising that so many Canadians are travelling abroad for medical treatment,” says Barua.
So while the provincial and federal politicians continue wrangling over what is the proper amount of money to put into health care, Canadians wait, wait, and wait some more. Or, they just cross the border to take measures into their own hands.
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