Long wait times are the vulnerable soft underbelly of the Canadian health system. Increasing legal and political pressure over quick access to elective surgeries — cataract extraction and joint replacement, for example — threatens to undermine public support for a system that is a part of our national identity.
Modern health care is expensive — so expensive that it costs more than many people are happy to pay for, whether through taxation, insurance premiums or out-of-pocket payments.
The Commonwealth Fund 2017 report ranked Canada last among 11 countries in timeliness of care. But this doesn’t mean Canadians are doomed to long waits for elective surgery forever.
Increasing the supply of surgery can be achieved by paying hospitals using “activity-based funding” payments for each procedure, rather than receiving an annual global budget in the hope that they will meet the demand.
Reimagining the way we use hospitals, incorporating new anesthesia techniques and virtual care to transform common procedures like joint replacement to day surgery, can reduce costs and free up hospital beds to further increase the supply of surgical procedures.
The demand for surgery is also elastic. Removing people who are not in dire need of surgery from waiting lists improves access for others. It also prevents the overtreatment of healthy people which is rampant in many areas of medicine – 32 per cent of patients waiting for cataract surgery in B.C. had near-perfect vision, in just one example.
Ironically, a legal challenge to the constitutionality of Canadian medicare before the B.C. Supreme Court is in part about access to arthroscopic knee surgery, a procedure that might actually cause more harm than benefit in some patient groups.
Wait times in Canada may be long on average, but they are not long everywhere. Take knee replacement surgery in Ontario. In 2017, only 78 per cent of people had their knee replacement within the recommended six months and 10 per cent waited longer than nine months. In spite of this, half of all people actually had surgery within three months.
Why do some people have surgery quickly and others wait?
Mostly because there is little coordination of surgical practices. Long ago, other industries adopted effective queue-management strategies. “Single-entry” models — where all people enter one queue and take the next available slot once they get to the front of the line — smooth out the waits and increase efficiency in banks, fast-food restaurants and Disneyland.
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