It seemed like a very good idea at the time, and a very good political move, too.
Having been told that Canada’s public health system needed lots more money, the federal and provincial governments decided in 2004 to spend another $41-billion on the system over the next decade, indexed at 6 per cent. Of this money, $5.5-billion would be directed into a Wait Times Reduction Fund. Upon being elected, Prime Minister Stephen Harper added another $612-million to this.
All this money went toward reducing wait times for just five procedures: hip and knee replacements, hip fractures, cataracts, heart bypasses and radiation therapy – all procedures disproportionately used by older Canadians. The initiative responded to the demand from many quarters that more money was needed for the entire health-care system, wait times in particular.
Eight years have passed, many billions of dollars have been spent and more procedures have been purchased. Yet, as the Canadian Institute of Health Information recently reported, no province met its benchmark time frames for these procedures. More worrying, after some initial improvement in wait times, no improvements have been recorded from 2010 to 2012. If anything, there has been backsliding.
Consider hip and knee replacements. These increased by 15 per cent from 2010 to 2012, at a cost to the treasury of $100-million. Nevertheless, wait times for hip replacements went up in five provinces and for knees in seven provinces.
The CIHI concluded: “Demand is rising at a rate that is outpacing the ability of health systems to keep up.” In other words, spend more money and do more procedures, yet fall farther behind.
Why? There are more older people every year, and older people drive greater demand for artificial joints. Also, a big increase in demand has come from people 45 to 54 years of age, some of whom suffer from osteoarthritis and obesity. Better prostheses mean surgeries can be done on younger people with greater assurance that the artificial joint will last.
If wait times are rising again, imagine two years from now, when federal increases for health transfers to the provinces fall from 6- to 4-per-cent increases, with no money targeted to these five procedures. Unless something is done, wait times will shoot up again – and wait times in Canada are already long by world standards. That “something” should not be an infusion of even more money, a strategy already tried and found wanting.
As the CIHI noted in a previous report, “Canada’s current wait time performance is poor compared with that of other countries.” People with maladies that are less than life-threatening experience the longest waits for surgeries in the advanced industrial world. The system is also plagued by long waits to be seen by family physicians, by specialists and in emergency departments.
In 2004, the governments decided to focus on five procedures. That the results have been modest to discouraging is not surprising.
The OECD’s health economics department has studied wait times and strategies to deal with them in the 33 member countries. As OECD chief health economist Mark Pearson told an Ottawa conference recently, “Almost every country has tried increasing funding – with little effect.”
He explained how countries that have tried to spend their way to reduced wait times have experienced initial decreases in wait times, only to see them rise again. Canada didn’t learn from these unhappy experiences; it repeated them.
What seems to work best is to back wait-time guarantees by way of penalties to hospitals or regional health authorities, and/or to give patients the freedom to choose where to go if they cannot get treatment on a timely basis. “Competition, where necessary, is a good agent for change,” Mr. Pearson argued.
Britain, New Zealand and Portugal are among the countries that have slashed wait times. In 2000, nearly 42,000 New Zealanders had been waiting more than six months for treatment and specialist’s assessments. Today, the figure is about 2,800. In Portugal, people who had waited up to 75 per cent of the wait time guarantee got vouchers to shop around for faster service. Over a six-year period, wait times fell dramatically.
In Canada, alas, new money bought temporary but not sustained improvement.