In recent years, patients treated by the Canadian health care system have increasingly experienced lengthy waits to see providers.
According a new study on medical care in Canada, released in October 2006 by the Fraser Institute, "waiting times are the legacy of a medical system offering low expectations cloaked in lofty rhetoric."
Since the mid-1980s, the Vancouver-based think tank has produced an annual report on how long patients are required to wait for medical care in Canada. As a result of the group's research, treatment waiting times are now part of the public policy debate on the quality of the Canadian health care system.
Waiting …
In its 16th annual installment, the report titled "Waiting Your Turn" tracks how waiting times vary across Canadian provinces depending on the type of treatment needed. The report also documents waiting times for referral to specialists and the subsequent amount of time spent waiting for actual treatment from the specialist.
"Despite all of the promises made by Canada's provincial and federal governments, and despite the fact that Canadians are spending more on health care than ever before, the total wait time in Canada continues to hover near the 18-week mark as it has since 2003," coauthor Nadeen Esmail said in an interview for this article. "Equally troubling is the reality that the total wait time in 2006 is 91 percent longer than it was in 1993."
These findings should give pause to proponents of universal coverage, who often cite Canada as an example of a country where health care costs less than care in the United States and everyone has free health care at the point of service.
"While many proclaim Canada's Medicare program to be one of the best in the world, or suggest it should be the model for reform in the United States," Esmail said, "the reality is that health spending in Canada outpaces that in most other developed nations that, like Canada, guarantee access to care regardless of ability to pay, and yet access to health care in this country lags that available in most of these other nations."
… and Waiting
In 2006, the average amount of time spent waiting to receive treatment after referral by a general practitioner averaged 17.8 weeks across Canada. At 14.9 weeks, Ontario had the shortest waits. Prince Edward Island, Saskatchewan, and New Brunswick had average waits of 25.8 weeks, 28.5 weeks, and 31.9 weeks, respectively.
Patients referred to a neurosurgeon waited an average of 21 weeks just to see a specialist. Getting treatment required an additional 10.7 weeks.
Patients waited an average of 16.2 weeks to see an orthopedic surgeon, and another 24.2 weeks for treatment to be performed after the initial visit.
The number of people routinely waiting for services is staggering, according to the report. In 2003, the most recent year for which data were available from Statistics Canada, approximately 1.1 million people had trouble accessing care on a timely basis.
About 201,000 had problems obtaining non-emergency services. An additional 607,000 had problems getting in to see a specialist, and about 301,000 patients experienced problems obtaining diagnostic procedures.
"So much for the myth of government-run health care being compassionate and fair," said David Gratzer, a Canadian doctor and senior fellow at the Manhattan Institute. "Canadians wait and wait and wait."
Rationing
In Canada, waiting lists are considered a way of rationing medical care and holding down health care spending. Because health care in Canada is largely free at the point of service, demand is likely to exceed supply.
In a typical market system, the price would adjust to the point where the quantity of services provided is equal to the amount patients are willing to buy. But in a system devoid of a market mechanism, scarce resources are rationed through means other than price.
"The long waits for needed care in Canada show the danger of abandoning markets in favor of central planning," explained Sean Parnell, vice president of external relations at The Heartland Institute, an Illinois-based think tank. "Just as there were long lines for food and other basic necessities in the old Soviet Union because planners couldn't accurately match supply with demand, the politicians and bureaucrats who run health care in Canada can't provide enough health care to meet the citizens' needs."
Gratzer agreed.
"It's like the old Soviet system," Gratzer said. "Everything is free, but nothing is readily available. Except that we're not talking about lining up for toilet paper in Russia in 1976, but queuing for surgery in Canada in 2006."
Economists generally agree such "non-price" rationing of resources is less efficient than a system that uses prices. One reason is that productivity is lost when people are unable to work due to treatment delays. Also, the risk of death while waiting is higher for serious conditions such as cardiac care.
Waiting lists are consequences of the way the Canadian health care system is structured, not a lack of money, critics say.
"The fact that this is the 16th annual report on wait lists for needed care should be enough to prove that the problem isn't a temporary one that can be fixed with just a little more money, as defenders of Canada's government-run system have claimed for years," Parnell said.
"Long waits and widespread denial of needed care are a permanent and necessary part of government-run systems," Parnell noted.
Spending
According to the study, Canadian provinces with higher spending per capita did not experience shorter wait times than provinces that spent less.
In fact, increased spending was associated with longer waits, unless the increased spending was targeted to physicians and pharmaceuticals.
"The current health care model simply does not deliver to Canadians the access to care they should expect for the amount of money their governments are spending," Esmail said.